Anatomy and Significance of Fixation of the Lumbosacral Nerve Roots in Sciatica

Spencer, David; Irwin, George S.; Miller, James A.

doi:10.1097/00007632-198309000-00014

Cited by 126 publications

(55 citation statements)

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“…While Mirovsky et al [5] have had no explanation for it, Kornberg has suggested that absence of the dural attachments to the posterior longitudinal ligaments that fix the lumbar nerve roots at some levels might explain the situation [4,6]. He has suggested that in the absence of the dural ligaments, the ipsilateral nerve root can simply be displaced posteriorly without being compressed significantly, while the contralateral nerve root is shifted laterally into the lateral recess, where it is exerted to significant contact force.…”

Section: Discussionmentioning

confidence: 99%

Lumbar disk herniation with contralateral symptoms

Sucu

Gelal

2005

Eur Spine J

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IntroductionDuring the workup of a patient with leg pain, finding a contralateral disk herniation without any significant abnormality on the ipsilateral side on imaging studies is a dilemma for a doctor. He is faced with the problem of deciding whether or not the presenting symptoms are related to the herniated disk. In such a situation, the spinal surgeon fears to offer operation due to the risk of failed back surgery syndrome and he either withholds surgery or chooses to explore both sides of the spinal canal not to miss a lesion that might be responsible for the symptoms. However, exploring the side without lesions on imaging studies in addition to diskectomy not only increases the operation time, but also doubles complication risks. Several authors have reported on patients with lumbar herniated disks and contralateral symptoms who recovered after operation, but all of them had operated the patients from both sides of the canal [2,4,5]. Therefore, in these cases, it is not possible to make sure that relief of symptoms were related only to removal of herniated disks; decompression at the symptomatic side might have also influenced the recovery.We present a series of five patients with lumbar herniated disks and contralateral symptoms. In all patients, herniated disks were removed without intervention to the contralateral side. To our knowledge, this is the first reported series of such patients who were operated only from the herniation side. The possible mechanisms of how contralateral symptoms predominate in these patients are also discussed. Hasan Kamil Sucu Fazıl GelalLumbar disk herniation with contralateral symptoms Abstract The aim of the study is to determine if leg pain can be caused by contralateral lumbar disk herniation and if intervention from only the herniation side would suffice in these patients. Five patients who had lumbar disk herniations with predominantly contralateral symptoms were operated from the side of disk herniation without exploring or decompressing the symptomatic side. Patients were evaluated preand postoperatively. To our knowledge, this is the first reported series of such patients who were operated only from the herniation side. The possible mechanisms of how contralateral symptoms predominate in these patients are also discussed. In all patients, the shape of disk herniations on imaging studies were quite similar: a broad-based posterior central-paracentral herniated disk with the apex deviated away from the side of the symptoms. The symptoms and signs resolved in the immediate postoperative period. Our data clears that sciatica can be caused by contralateral lumbar disk herniation. When operation is considered, intervention only from the herniation side is sufficient. It is probable that traction rather than direct compression is responsible from the emergence of contralateral symptoms.

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Section: Discussionmentioning

confidence: 99%

Lumbar disk herniation with contralateral symptoms

Sucu

Gelal

2005

Eur Spine J

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“…The lateral canal contains nerve roots, the main tissue capable of producing leg pain, while dural tissue in the central canal is less sensitive [18]. Also, the extrathecal intraspinal nerve roots are more fixed than the roots inside the thecal sac, being therefore more susceptible to injury [32]. The role played by the reduction in the sagittal diameter of S1 in symptomatic patients is not well understood.…”

Section: Lateral Canalmentioning

confidence: 99%

Morphometry of the lower lumbar vertebrae in patients with and without low back pain

Santiago¹,

Milena²,

Herrera³

et al. 2001

Eur Spine J

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IntroductionMany studies point out that the space available in the lumbar canal is the key to the development of discal symptoms [12] but may also be important in other causes of lumbar pain (hypertrophy of bone structures, vertebral displacement, etc.) [8]. The size of the spinal canal is determined by different factors. First of all are genetic factors, the phenotypic expression of which can be altered by direct local injury (trauma, infection, etc.) or repercussions of systemic disturbances (malnutrition, cardiovascular illness, etc.) to the spinal column during its development [1,6,26,27]. Although degenerative alterations have been described in the young [33], these are more frequent when spinal development has ended, and therefore its effects on the dimensions and morphology of the canal could be differentiated with respect to congenital and developmental alterations [15,28].The different rates of growth of different dimensions of an organism are referred to as allometric growth. The allometric relationship between two diameters may be calculated by ontogenetic data (measurements on individuals of different ages) or static data (measurements on individuals of similar age but different size) [10]. This possibility moved us to take a series of measurements in the lumbar Abstract The authors made several measurements in the lower lumbar vertebrae of patients with and without low back pain. Our objective was to determine the allometric relationships between different dimensions of the lumbar canal, the effects on these from degenerative disease, and differences between the symptomatic and asymptomatic populations. We compared 119 patients suffering from low back and sciatic pain and 39 subjects without lumbar symptoms as determined by computed tomography (CT). The following measurements were made: sagittal diameter of the canal, interpedicular distance, interarticular distance, and anteroposterior diameter of lateral recess and foramen. With respect to the patients with lumbar pain, the asymptomatic group proved to have wider foramina from L3 to L5 and wider sagittal diameters in S1. The patients with canal stenosis revealed lower figures for all diameters of the central canal, lateral recess of L4, and foramina of L4 and L5. Patients with lumbarization showed smaller diameters of the central canal. Conclusion. There is an allometric relationship between the dimensions of the central canals. This relationship is less evident with lateral canals. The patients without lumbar symptoms had wider foramina and sagittal diameters in S1 than those with lumbar symptoms. Of these, patients who developed symptoms of canal stenosis demonstrated smaller diameters in central and lateral canals. Of the developmental anomalies, lumbarization proved to be associated with canal stenosis due to smaller diameters of the central canals.

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“…This spinal canal can be narrow congenitally or through arthrosic lesions arising from its strong biomechanical involvement [1]. The lumbar canal stenosis causes the suffering of the vessel wall roots of which intermittent claudication is the most characteristic clinical manifestation [2].…”

Section: Introductionmentioning

confidence: 99%

Normative dimensions of lumbar canal and dural sac by computer tomography in Togo

Amadou¹,

Sonhaye²,

James³

et al. 2017

Med Imaging Radiol

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Objective: To determine through CT scan, the biometrics of the spinal canal and lumbar dural sac of adults in Togo. Material and method: Twelve month prospective study at Campus Teaching Hospital and Sylvanus Olympio Univesristy Hopsital Center, concerning people over 18 years of age who presented neither any clinical sign nor spinal defect. Distances measured were the antero posterior diameter (APD1) and inner pedicular diameter (IPD) of the lumbar canal, the antero posterior diameter (APD2) and transverse diameter (TD) of the dural sac, followed by the evaluation of APD2/APD1 (R1) and TD/IPD (R2) ratio. Results: The mean age was 38+/9.34 years. The general average APD of the lumbar canal (APD1) was 15.41±0.55mm, with a minimal average of 10.48±0.57mm and a maximal average of 25.00±2.60mm. The general average IPD was 23.27±1.67mm, with a minimal average of 13.68±1.46mm and a maximal average of 33.68±1.46mm. The average APD of the dural sac (APD2) was 11.60±0.66mm, with a minimal average of 10.7±0.66mm and a maximal average of 10.7±0.66mm. The average TD of the dural sac was 15.55±1.54mm, with a minimal average of 14.03±2.43mm and a maximal average of 17.63±1.82mm. The evaluation of the ratio ADP2/ADP1 (R1) found general average R1 of 0.80±0.04, with a minimal average R1 of 0.76±0.06 and a maximal average R1 of 0.85±0.07. The ratio TD/IPD (R2) found an average R2 of 0.69±0.14, with a minimal average of 0.5±0.12 and a maximal average of 0.84±0.08. Conclusion:The diameters of the lumbar canal and dural sac in Togo do not differ significantly from those described in the literature.

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Anatomy and Significance of Fixation of the Lumbosacral Nerve Roots in Sciatica

Cited by 126 publications

References 0 publications

Lumbar disk herniation with contralateral symptoms

Lumbar disk herniation with contralateral symptoms

Morphometry of the lower lumbar vertebrae in patients with and without low back pain

Normative dimensions of lumbar canal and dural sac by computer tomography in Togo

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