PDF herunterladen
J Neurol Surg A Cent Eur Neurosurg 2019; 80(02): 109-115
DOI: 10.1055/s-0038-1673400
Original Article
Georg Thieme Verlag KG Stuttgart · New York

Extradural Characteristics of the Origins of Lumbosacral Nerve Roots

Zora Haviarova
1   Faculty of Medicine, Comenius University, Institute of Anatomy, Faculty of Medicine, Comenius University, Bratislava, Slovakia
,
Viktor Matejcik
2   Department of Neurosurgery, Faculty of Medicine, Comenius University, Bratislava, Slovakia
,
Roman Kuruc
3   Institute of Forensic Medicine, Faculty of Medicine, Comenius University, Bratislava, Slovakia
4   Health Care Surveillance Authority, Bratislava, Slovakia
,
Ján Líška
5   Institute of Histology and Embryology, Univerzita Komenskeho v Bratislave, Bratislava, Slovakia
,
Juraj Steno
2   Department of Neurosurgery, Faculty of Medicine, Comenius University, Bratislava, Slovakia
› Institutsangaben
Weitere Informationen

Publikationsverlauf

27. Oktober 2017

16. April 2018

Publikationsdatum:
31. Oktober 2018 (online)

Auch verfügbar auf
    Lizenzen und Reprints

Abstract

Background and Study Aims A great number of unsuccessful intervertebral herniated disk surgeries in the lumbosacral region have highlighted the importance of a comprehensive knowledge of the different types of nerve root anomalies. That knowledge gained by anatomical studies (and intraoperative findings) might contribute to better results. In our study we focused on intraspinal extradural lumbosacral nerve root anomalies and their possible role in radiculopathy.

Material and Methods The study was performed on 43 cadavers within 24 hours after death (32 men and 11 women). Bodies were dissected in the prone position, and a laminectomy exposed the entire spinal canal for the bilateral examination of each spinal nerve root from its origin to its exit through the intervertebral foramen or sacral hiatus. Uncommon extradural features in the lumbosacral region were pursued and documented. The spinal dural sac was also opened, aimed at recognizing the normotyped, prefixed, or postfixed type of plexus.

Results A total of 20.93% of anomalies of extradural lumbosacral nerve root origins were observed, with the normotyped plexus prevailing. We observed atypical spacing of exits of lumbosacral roots (four cases), two roots leaving one intervertebral foramen (one case), extradural anastomoses (two cases), and missing extradural nerve root courses (two cases). The results were differentiated according to the normotyped, prefixed, or postfixed plexus type.

Conclusion Results of similar studies dealing with anomalies of lumbosacral nerve roots were aimed at improving the results of herniated disk surgeries because ∼ 10% of misdiagnoses are related to ignorance of anatomical variability. Our observations may help explain the differences between the clinical picture and generally accepted anatomical standards.

Keywords

spinal nerve root - lumbosacral - extradural course
 

  • References

  • 1 Arslan M, Cömert A, Açar HI. , et al. Nerve root to lumbar disc relationships at the intervertebral foramen from a surgical viewpoint: an anatomical study. Clin Anat 2012; 25 (02) 218-223
    CrossrefPubMedSuche in Google Scholar
  • 2 Dhar A, Pawar S, Prasad A, Ramani P. Nerve root anomalies detected intra-operatively technical nuances towards achieving a successful surgical outcome: our experience of three case reports at a tertiary level centre. Neurol Res 2017; 39 (04) 311-314
    CrossrefPubMedSuche in Google Scholar
  • 3 Kadish LJ, Simmons EH. Anomalies of the lumbosacral nerve roots. An anatomical investigation and myelographic study. J Bone Joint Surg Br 1984; 66 (03) 411-416
    PubMedSuche in Google Scholar
  • 4 Burke SM, Safain MG, Kryzanski J, Riesenburger RI. Nerve root anomalies: implications for transforaminal lumbar interbody fusion surgery and a review of the Neidre and Macnab classification system. Neurosurg Focus 2013; 35 (02) E9
    PubMedSuche in Google Scholar
  • 5 Zagnosi C. Reperto di un tipo non conosciuto di anastomosi nervosa delle radici spinali. Atti Soc Med Chir (Padova) 1949; 27: 48-52
    PubMedSuche in Google Scholar
  • 6 Ethelberg S, Riishede J. Malformation of lumbar spinal roots and sheaths in the causation of low backache and sciatica. J Bone Joint Surg Br 1952; ;34-B( (03) 442-446
    PubMedSuche in Google Scholar
  • 7 Bedeschi P, Bonola A. Anomalies of origin, course, length and diameter of the lumbar roots and their importance in the pathology of diskal hernia [in Italian]. Reumatismo 1956; 8 (05) 266-280
    PubMedSuche in Google Scholar
  • 8 Goffin J, Plets C. Association of conjoined and anastomosed nerve roots in the lumbar region. A case report. Clin Neurol Neurosurg 1987; 89 (02) 117-120
    CrossrefPubMedSuche in Google Scholar
  • 9 Postacchini F, Urso S, Ferro L. Lumbosacral nerve-root anomalies. J Bone Joint Surg Am 1982; 64 (05) 721-729
    CrossrefPubMedSuche in Google Scholar
  • 10 Kyoshima K, Nishiura I, Koyama T. Conjoined lumbosacral nerve roots--diagnosis by metrizamide myelography and metrizamide CT [in Japanese]. No Shinkei Geka 1986; 14 (07) 865-871
    PubMedSuche in Google Scholar
  • 11 Stambough JL, Balderston RA, Booth RE, Rothman RH. Surgical management of sciatica involving anomalous lumbar nerve roots. J Spinal Disord 1988; 1 (02) 111-114 ; discussion 114–115
    PubMedSuche in Google Scholar
  • 12 Yılmaz T, Turan Y, Gülşen I, Dalbayrak S. Co-occurrence of lumbar spondylolysis and lumbar disc herniation with lumbosacral nerve root anomaly. J Craniovertebr Junction Spine 2014; 5 (02) 99-101
    CrossrefPubMedSuche in Google Scholar
  • 13 Neidre A, MacNab I. Anomalies of the lumbosacral nerve roots. Review of 16 cases and classification. Spine 1983; 8 (03) 294-299
    CrossrefPubMedSuche in Google Scholar
  • 14 Haijiao W, Koti M, Smith FW, Wardlaw D. Diagnosis of lumbosacral nerve root anomalies by magnetic resonance imaging. J Spinal Disord 2001; 14 (02) 143-149
    CrossrefPubMedSuche in Google Scholar
  • 15 Scarf F, Dalman DE, Toleikis JR, Bunch WM. Dermatomal evoked potentials in the diagnosis of lumbar root entrapment. Surg Forum 1981; 32: 489-491
    PubMedSuche in Google Scholar
  • 16 Freguia F, Koeck K, Schmieder K, Grossauer S. Lumbar nerve root anomalies are still a diagnostic and therapeutic challenge: case report and review of literarure. SM J Clin Med Imaging. 2017; 3: 1010
    PubMedSuche in Google Scholar
  • 17 Keegan JJ. Relations of nerve roots to abnormalities of lumbar and cervical portions of the spine. Arch Surg 1947; 55 (03) 246-270
    PubMedSuche in Google Scholar
  • 18 Kikuchi S, Hasue M, Nishiyama K, Ito T. Anatomic and clinical studies of radicular symptoms. Spine 1984; 9 (01) 23-30
    CrossrefPubMedSuche in Google Scholar
  • 19 Matejčík V, Haviarová Z, Šteňo A, Kuruc R, Šteňo J. Intraspinal extradural variations of nerve roots. Ann Anat 2017; 211: 114-119
    CrossrefPubMedSuche in Google Scholar
  • 20 Chotigavanich C, Sawangnatra S. Anomalies of the lumbosacral nerve roots. An anatomic investigation. Clin Orthop Relat Res 1992; (278) 46-50
    PubMedSuche in Google Scholar
  • 21 Boden SD, Davis DO, Dina TS, Patronas NJ, Wiesel SW. Abnormal magnetic-resonance scans of the lumbar spine in asymptomatic subjects. A prospective investigation. J Bone Joint Surg Am 1990; 72 (03) 403-408
    CrossrefPubMedSuche in Google Scholar
  • 22 Arslan M, Cömert A, Açar Hİ. , et al. Lumbosacral intrathecal nerve roots: an anatomical study. Acta Neurochir (Wien) 2011; 153 (07) 1435-1442
    CrossrefPubMedSuche in Google Scholar
  • 23 Federative International Programme for Anatomical Terminology FIPAT. Terminologia Neuroanatomica. FIPAT.library.dal.ca. February 2017
    PubMed
  • 24 Rask MR. Anomalous lumbosacral nerve roots associated with spondylolisthesis. Surg Neurol 1977; 8 (02) 139-140
    PubMedSuche in Google Scholar
  • 25 Transfeld EE, Simons EH. Functional and pathological biomechanics of the spinal cord: an in vivo study. Paper presented at: International Society for the Study of the Lumbar Spine; June 7, 1982; Toronto, Ontario, Canada
    PubMed
  • 26 Henmi T, Terai T, Nagamachi A, Sairyo K. Morphometric changes of the lumbar intervertebral foramen after percutaneous endoscopic foraminoplasty under local anesthesia. J Neurol Surg A Cent Eur Neurosurg 2018; 79 (01) 19-24
    Thieme ConnectPubMedSuche in Google Scholar