Changes of lumbosacral nerve roots innervation in lumbar disc herniation patients with transitional vertebrae / 中国组织工程研究

BACKGROUND: Lumbosacral transitional vertebra is a commonly seen congenital spinal deformity, and the changes in the muscle innervation pattern and the sensory dermatomes of the lumbosacral nerve roots have been reported, but the changes and its guidance significance for the surgeries of lumbar disc herniation have not been clarified systematically. OBJECTIVE: To explore the possibility of changes in the muscle innervation pattern and the sensory dermatomes of the lumbosacral nerve roots when there is a lumbosacral transitional vertebra. METHODS: The study was in accordance with the ethical requirements of Affiliated Hospital of Binzhou Medical University, and the subjects and their families signed the informed consents. The medical records of 321 patients with single segment lumbar disc herniation who underwent surgical treatment were analyzed retrospectively. Lumbosacral transitional vertebrae were present in 38 of 321 patients (11. 8%). There were 26 cases of sacral lumbarization and 12 cases of lumbar sacralization. Among these 26 patients with sacral lumbarization, 23 had herniated discs at L5/S1 (L6) compressing the S1 (L6) nerve root. Of the 12 patients with lumbar sacralization, 8 had herniated discs at L3/4 compressing the L4 nerve root. In the 283 normally configured patients, 138 had herniated discs at L5/S1 compressing the Si nerve root, 95 had herniated discs at L4/L5 compressing the L5 nerve root, and 47 had herniated discs at L3/L4 compressing the L4 nerve root. The preoperative symptoms of Si nerve root compression in the patients with sacral lumbarization and of L4 nerve root compression in the patients with lumbar sacralization were compared with those of L4, L5 or Si nerve root compression in the patients with normal configuration. RESULTS AND CONCLUSION: (1) The distribution of motor function depression caused by Si nerve root compression was significantly different between sacral lumbarization patients group and normal group (P < 0. 05). (2) The distribution of motor function depression caused by L4 nerve root compression was also significantly different between lumbar sacralization patients group and normal group (P < 0. 05). (3) The motor function depression caused by Si nerve root compression in sacral lumbarization patients was similar to that of the L5 nerve root compression in the normal configuration, while the motor function depression caused by L4 nerve root compression in lumbar sacralization patients was similar to that of the U nerve root compression in the normal configuration. The analysis of the sensory dermatomes also showed similar results. (4) Our results suggest that the function of lumbosacral nerve roots changes in patients with transitional vertebrae. The Si nerve roots in patients with sacral lumbarization tend to serve the usual function of L5 nerve roots (nerve roots move up), and the L4 nerve roots in patients with lumbar sacralization tend to serve the usual function of L5 nerve roots (nerve roots move down).

Anomalias dos nervos lombossacrais em natimortos a termo. Estudo anatômico / Anomalies of the lumbosacral nerve roots in stillborns. An anatomical study

Contexto: Existe controvérsia entre autores quanto à incidência de variações anatômicas dos nervos espinhais lombossacros. A incidência dessas anomalias nervosas varia de 0% a 30% como verificado em estudos anatômicos em cadáveres adultos de diferentes nacionalidades, de 2,0% a 4,0% em estudos de imagem diagnóstica e de 0,34% a 10% em séries cirúrgicas. Objetivo: Determinar a incidência de anomalias anatômicas nos nervos espinhais lombossacros em 40 natimortos a termo de nacionalidade brasileira. Métodos: O segmento lombossacro da coluna vertebral de 40 natimortos, provenientes do laboratório de patologia clínica do Hospital Universitário da Universidade Federal de Sergipe (UFS), foi estudado no Laboratório de Neuroanatomia do Departamento de Morfologia da UFS. Foram excluídos aqueles casos que possuíam síndromes ou qualquer defeito orgânico associado. Os espécimes anatômicos foram fixados com solução de formaldeído a 10%, infundida por meio da veia umbilical. As peças foram preparadas com a ressecção em bloco das partes moles dorsais, processos espinhosos e lâminas da décima vértebra torácica até o sacro. Resultado: Neste estudo, foram encontradas seis variações anatômicas dos nervos espinhais lombossacros, em seis diferentes espécimes, de quatro tipos, totalizando 15% das peças. As variações anatômicas dos nervos espinhais lombossacros foram classificadas em oito tipos, sendo a anastomose intradural a mais presente. O quinto nervo lombar foi o mais frequentemente comprometido Não foi observada diferença significativa quanto ao sexo e lado envolvido. Conclusão: O presente estudo enfatiza a importância do conhecimento dessas anomalias anatômicas durante os procedimentos cirúrgicos na região lombossacral, pois não se trata de evento muito raro.

Context: There is such controversy among authors about the real incidence of lumbosacral nerve roots anomalies. The incidence ranges from 0% to 30% in anatomic studies in different populations, from 2% to 4% in diagnostic image studies and 0.34% to 10% in surgical series. Objective: To determine the incidence of anatomical abnormalities of the lumbossacral spinal nerves in 40 Brazilian stillborns. Methods: The segment of the lumbosacral spine of 40 stillborns, from the clinical pathology laboratory at the University Hospital of Federal University of Sergipe (UFS) was studied in the Laboratory of Neuroanatomy, Department of Morphology of the UFS. We excluded those cases that had any defects or syndromes associated. The anatomical specimens were fixed with formaldehyde solution 10%, infused through the umbilical vein. The specimens were prepared with en bloc resection of the soft dorsal spinous processes and laminae from the tenth thoracic vertebra to the sacrum. Results: In this study, were found four types of anatomical variations of lumbosacral spinal nerves in six different specimens, accounting for 15% of the specimens. The fifth lumbar nerve was the most frequently involved (66%).The anatomical variations of lumbosacral spinal nerves were classified into eight types, and the intradural anastomosis was the most frequent. There was no significant difference regarding gender and side involved. Conclusion: Our study emphasizes the importance of knowledge of these anatomical anomalies during surgical procedures in the lumbosacral region because they are not too rare.

Avulsion Injury of Lumbosacral Nerve Roots Associated with Femur Fractures: A case Report / 대한정형외과학회잡지

Avulsion of cervical nerve roots by traction injury to the shoulder girdle is well known, but, on the other hand, traumatic avulsion of lumbosacral nerve roots is exceedingly rare. The rarity of avulsion of lumbosacral nerve roots reflects the natural laxity of the roots and the strength and stability of the bony pelvis which offers support and protection to the nerve roots against stretching and rupture during trauma. We experienced a case of avulsion injury of L-S nerve roots associated with femoral shaft fracture. The myelography and C-T findings demonstrated multiple pseudomenigocele of dural sac at the level of the right L2, 3, 4, 5 and Sl S2 nerve roots.