Nerve root anomalies: making sense of a complicated literature

Schmidt, Cameron; Rustagi, Tarush; Alonso, Fernando; Loukas, Marios; Oskouian, Rod J.; Tubbs, R. Shane

doi:10.1007/s00381-017-3457-3

Cited by 9 publications

(9 citation statements)

References 45 publications

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“…PLIF involves cage insertion through the disc space. Although two cages are inserted bilaterally in the original technique, situations can arise in which only one cage can be inserted unilaterally, such as in severe asymmetric disc space narrowing, severe adhesion due to previous laminectomy or discectomy, or anatomic root variation [3]. In the above cases, unilateral cage insertion, posterolateral fusion, or anterior lumbar interbody fusion could be considered as an alternative [4].…”

Section: Introductionmentioning

confidence: 99%

Clinical and radiological outcomes in patients who underwent posterior lumbar interbody fusion: comparisons between unilateral and bilateral cage insertion

Cho

Hwang

Lee

et al. 2021

BMC Musculoskelet Disord

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Background Although the original technique involves inserting two cages bilaterally, there could be situations that only allow for insertion of one cage unilaterally. However, only a few studies have compared the outcomes between unilateral and bilateral cage insertion. The purpose of this study was to compare the clinical and radiological outcomes in patients who underwent posterior lumbar interbody fusion (PLIF) between unilaterally and bilaterally inserted cages. Methods Among 206 eligible patients who underwent 1- or 2-level PLIF, 78 patients were 1:3 cohort-matched by age, sex, and operation level (group U, 19 patients with unilateral cages; and group B, 57 patients with bilateral cages). Fusion status was evaluated by computed tomography (CT) scans at postoperative 1 year. Clinical outcomes were measured by visual analog scale (VAS), Oswestry Disability Index (ODI), and EQ-5D. Radiological and clinical parameters were compared between the two groups. Risk factors for pseudarthrosis were also analyzed by multivariate analysis. Results The demographic data were not significantly different between the two groups. However, previous laminectomy, asymmetric disc collapse, and fusion at L5-S1 level were more frequently found in group U (P = 0.003, P = 0.014, and P = 0.014, respectively). Furthermore, pseudarthrosis was more frequently observed in group U (36.8%) than in group B (7.0%) (P = 0.004). Back pain VAS was higher in group U at postoperative 1 year (P = 0.033). Lower general activity function of EQ-5D was observed in group U at postoperative 1 year (P = 0.035). Older age (P = 0.028), unilateral cage (P = 0.007), and higher bone mineral density (P = 0.033) were positively correlated with pseudarthrosis. Conclusions Unilaterally inserted cage might be a possible risk factor for pseudarthrosis when performing PLIF, which could be related with the difficult working conditions such as scars due to previous laminectomy or asymmetric disc collapse. Furthermore, suboptimal clinical outcomes are expected following PLIF with unilateral cage insertion at postoperative 1 year regardless of similar clinical outcomes at postoperative 2 year. Therefore, caution is advised when inserting cages unilaterally, especially under above-mentioned conditions in terms of its possible relationship with symptomatic pseudarthrosis.

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Section: Introductionmentioning

confidence: 99%

Clinical and radiological outcomes in patients who underwent posterior lumbar interbody fusion: comparisons between unilateral and bilateral cage insertion

Cho

Hwang

Lee

et al. 2021

BMC Musculoskelet Disord

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“…Without adequate decompression by foraminotomy in addition to the laminectomy, the stenosis and subsequently the symptoms are not relieved. In such cases, an undiagnosed CNR can be considered as a possible cause for failed spinal surgery (13,14,21). As it is said, when it comes to women age is an important issue.…”

Section: Discussionmentioning

confidence: 99%

“…On its own in normal conditions the CNR anomaly is usually asymptomatic. However, due to overcrowding of the nerve canal, compression of different origin may lead to radiculopathy, neurogenic claudication and neurological deficit (12,13,14).…”

Section: Introductionmentioning

confidence: 99%

A combination of pathologies - facet joint synovial cyst, epidural lipomatosis and conjoined nerve root anomaly in the lumbar spine of a 45-year-old patient. A case report

Harizanova

Enchev

Iliev

2019

SSM

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Facet joint synovial cysts are abnormal fluid-filled cystic formations that develop from a degenerative process of the facet joints. Spinal epidural lipomatosis is a process of excessive accumulation of fat in the epidural space. Conjoined nerve root (CNR) anomaly refers to an anatomical variation in which two adjacent nerve roots share a common dural sleeve. The aforementioned three rare pathologies cause the same pathological process of stenosis, therefore compressing the nervous structures. A 45-year-old female patient was admitted to the Department of Neurosurgery with severe low back and radicular pain, and numbness along her left leg. Antalgic posture, painful paravertebral muscle tenderness, L4 radiculopathy, and L5 and S1 dermatome hypoesthesia on the left as well as positive straight leg raising sign (Laseque) were present upon examination. CT and MRI scanning showed stenosis on L4-L5 level caused by bilateral synovial cyst formation. Microsurgical decompression by foraminotomy at L4-L5 level on the left with dissection of the synovial cyst and epidural lipomatosis was performed. In the course of the operation CNR anomaly was discovered. The complete decompression alleviated the symptoms and after 3 uneventful postoperative days the patient was discharged. Spinal stenosis causing compression upon nervous structures is a process that could be caused by a number of conditions. The incidence of rare pathologies and anomalies or even the more rarely occurring combination

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“…Existing classification systems for spinal nerve root anomalies are numerous and substantially different from one another. Spinal nerve root abnormalities are known to be congenital deformities 1 and are perceived to be the result of incorrect migration of nerve fibers, causing structural and spatial disorganization. 2 - 3 Spinal nerves are formed from the ventral and dorsal roots in the spinal canal.…”

Section: To the Editormentioning

confidence: 99%

“…In 1962, Cannon et al first identified the 3 most common variations of nerve root anomalies: conjoined Type I, anastomosed Type II, and transverse Type III. 1 - 2 In 1982, Postacchini et al classified common spinal nerve root abnormalities into 5 different variations. 3 In 1983, Neidre and MacNab expanded Cannon's classification based on the angle and positioning of root emergence.…”

Section: To the Editormentioning

confidence: 99%

Proposed Unifying Classification Criteria for Spinal Nerve Root Variations

Николенко

Shkarubo

Zmeeva

et al. 2021

TOJ

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Nerve root anomalies: making sense of a complicated literature

Abstract: This comprehensive review examines the anatomy and characteristics of NRAs; their surgical, radiographic, and cadaveric prevalence rates; clinical and radiographic presentations; and surgical management. In addition, the top 5 NRA classification systems are presented and related.

Cited by 9 publications

References 45 publications

Clinical and radiological outcomes in patients who underwent posterior lumbar interbody fusion: comparisons between unilateral and bilateral cage insertion

Clinical and radiological outcomes in patients who underwent posterior lumbar interbody fusion: comparisons between unilateral and bilateral cage insertion

A combination of pathologies - facet joint synovial cyst, epidural lipomatosis and conjoined nerve root anomaly in the lumbar spine of a 45-year-old patient. A case report

Proposed Unifying Classification Criteria for Spinal Nerve Root Variations

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