scholarly journals A Transverse Tri-Anastomotic Conjoined Nerve Root Discovered During a Lumbar Discectomy L5-S1

2017 ◽  
Vol 7 (3) ◽  
pp. 63-64
Author(s):  
Keyvan Mostofi ◽  
Christophe Hardit ◽  
Reza Karimi Khouzani
Keyword(s):  
Nerve Root ◽  
Lumbar Discectomy ◽  
Conjoined Nerve Root

scholarly journals Triple Conjoined Nerve Root—An Unreported Anatomical Variant and Its Surgical Implications

2020 ◽  
Vol 9 (03) ◽  
pp. 215-218
Author(s):  
Kelly Gassie ◽  
Krishnan Ravindran ◽  
Gazanfar Rahmathulla ◽  
H. Gordon Deen
Keyword(s):  
Nerve Root ◽  
Root Anatomy ◽  
Neurological Injury ◽  
Herniated Disc ◽  
Anatomical Variant ◽  
Nerve Root Injury ◽  
Root Injury ◽  
Conjoined Nerve Roots ◽  
High Degree ◽  
Conjoined Nerve Root

AbstractConjoined nerve roots are an infrequent and uncommon finding, rarely noted preoperatively. The conjoined root anomaly has potential for significant neurological injury during surgery. Preoperative recognition may avert disastrous nerve root injury but requires a high degree of clinical suspicion. We present the case of a 44-year-old patient with left L5/S1 radiculopathy caused by a herniated disc. During surgery we identified a triple conjoined nerve root anatomy. This anatomical variant, to our knowledge, has not been reported in literature. We describe the anatomical findings and surgical implications.

scholarly journals Conjoined nerve root: case illustration

2020 ◽  
Vol 32 (6) ◽  
pp. 788-789
Author(s):  
Andrew K. Chan ◽  
Rory R. Mayer ◽  
Praveen V. Mummaneni ◽  
Dean Chou
Keyword(s):  
Nerve Root ◽  
Case Illustration ◽  
Conjoined Nerve Root

Imaging features suggestive of a conjoined nerve root on routine axial MRI

2007 ◽  
Vol 37 (2) ◽  
pp. 133-138 ◽  
Author(s):  
Su Jin Song ◽  
Joon Woo Lee ◽  
Ja-Young Choi ◽  
Sung Hwan Hong ◽  
Na Ra Kim ◽  
...  
Keyword(s):  
Nerve Root ◽  
Imaging Features ◽  
Conjoined Nerve Root

Physiologic Changes of Nerve Root During Posterior Lumbar Discectomy

Spine ◽  
1995 ◽  
Vol 20 (6) ◽  
pp. 654-659 ◽  
Author(s):  
Hisao Matsui ◽  
Hideki Kitagawa ◽  
Yoshiharu Kawaguchi ◽  
Haruo Tsuji
Keyword(s):  
Nerve Root ◽  
Lumbar Discectomy

The perioperative use of corticosteroids and bupivacaine in the management of lumbar disc disease

1993 ◽  
Vol 78 (3) ◽  
pp. 383-387 ◽  
Author(s):  
Ryan S. Glasser ◽  
Robert S. Knego ◽  
Johnny B. Delashaw ◽  
Richard G. Fessler
Keyword(s):  
Hospital Stay ◽  
Nerve Root ◽  
Skin Incision ◽  
Lumbar Discectomy ◽  
Fat Graft ◽  
Control Group ◽  
Lumbar Microdiscectomy ◽  
Anesthetic Agents ◽  
Long Acting ◽  
Group 1

✓ The introduction of microdiscectomy to lumbar spine surgery has resulted in a significant decrease in postoperative pain and length of hospital stay. Intraoperative application of long-acting local anesthetic agents has been used for many general and neurosurgical procedures for the management of postoperative pain. In addition, many surgeons routinely use intraoperative corticosteroids during lumbar discectomy to reduce traumatic nerve root inflammation. However, the efficacy of intraoperative long-acting local anesthetic agents and corticosteroids for reduction of postoperative discomfort has not been reported for lumbar discectomy. This study evaluated 32 patients at a university-based Veterans Administration hospital undergoing lumbar microdiscectomy. All 32 patients presented with radicular symptoms and had radiographic confirmation of a herniated nucleus pulposus. These patients were divided into three groups. Group 1 (12 patients) received 160 mg intramuscular Depo-Medrol (methylprednisolone acetate) and 250 mg intravenous Solu-Medrol (methylprednisolone sodium succinate) at the start of the operation. A macerated fat graft soaked in 80 mg Depo-Medrol was placed over the affected nerve root following discectomy. In addition, 30 ml of 0.25% bupivacaine was infiltrated into the paraspinal musculature at skin incision and during closure. Group 2 (10 patients) received 30 ml of 0.25% bupivacaine infiltrated into the paraspinal musculature at skin incision and at closure. In this group of patients, a saline-soaked fat graft was placed over the affected nerve root. Group 3 (10 patients) acted as a control group, undergoing lumbar microdiscectomy without corticosteroids or bupivacaine. Patients receiving bupivacaine and corticosteroids (Group 1) had a statistically significantly shorter hospital stay (1.4 days) compared to the control group (4.0 days) (p = 0.0004, Mann-Whitney U-test). Patients in Group 1 required less postoperative narcotic analgesia than the other groups. Finally, a larger percentage of patients in Group 1 reported complete relief of back and radicular pain on postoperative Day 1 compared to other groups. Postoperative complications and functional outcome were not different between the groups. These results indicate that the combination of long-acting anesthetic agents and corticosteroids can reduce postoperative discomfort and subsequently the length of postoperative hospital stay.

scholarly journals Modified Percutaneous Lumbar Foraminoplasty and Percutaneous Endoscopic Lumbar Discectomy: Instrument Design, Technique Notes, and 5 Years Follow-up

2017 ◽  
Vol 1 (21;1) ◽  
pp. E85-E98 ◽  
Author(s):  
Zhen-zhou Li
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Nerve Root ◽  
Lumbar Discectomy ◽  
Leg Pain ◽  
Low Back ◽  
Percutaneous Endoscopic Lumbar Discectomy ◽  
Tendon Reflex ◽  
Endoscopic Lumbar Discectomy

Background: Conventional percutaneous endoscopic lumbar discectomy (PELD) with an “insideoutside” technique has 4.3% – 10.3% surgical failure rate, especially in central herniated discs (HDs), migrated HDs, and axillary type HDs. PELD with foraminoplasty has been used for complex HDs. Percutaneous lumbar foraminoplasty (PLF), which is performed with a trephine or bone reamer introduced over a guidewire without a protective working cannula in the original Tessys technique, can quickly cut the hypertrophied bony structure under fluoroscopic guidance, and risk injury to the exiting and traversing nerve roots. Study Design: A prospective cohort study. Setting: Hospital and outpatient surgical center. Objective: To evaluate the outcome and safety of modified PLF-PELD with a specially designed instrument for complex uncontained lumbar HDs. Method: From April of 2007 to April of 2009, 148 patients with uncontained lumbar HDs were treated with modified PLF-PELD. Magnetic resonance imaging (MRI) checkup was performed the next morning after the operation. Outcomes of symptoms were evaluated by follow-up interviews at 3 months, 6 months, one year, and 5 years after surgery. Low back pain and leg pain were measured by visual analog scale (VAS) score (1 – 100). Functional outcomes were assessed by using the Oswestry Disability Index (ODI) and modified MacNab criteria. Result: Follow-up data were obtained from 134 cases, including 14 cases on L3-4, 78 cases on L4-5, and 42 cases on L5-S1. One hundred-eight cases were prolapse type, while 26 cases were sequestration type. Pre-operative symptoms and deficits included nerve root dermatome hypoesthesia in 98 patients (73%), nerve root myotome muscle weakness in 32 patients (23%), and weakening or disappearance of tendon reflex in 43 patients (32%). No case required conversion to an open procedure during the surgery. Low back pain and leg pain were significantly relieved immediately after surgery in all patients. MRI examination showed adequate removal of HD in all patients. VAS scores and ODI values were significantly lower at all time points after surgery than before surgery. The percentage of pain relief in leg pain was significantly higher than that in low back pain (P < 0.01). But there was no significant correlation between duration of the preoperative symptoms and the percentage of pain relief. MacNab scores at 5 years after surgery were obtained from 134 patients. Seventy-five cases were rated “excellent”; 49 were rated “good,” Five patients experienced heavier low back pain, thus being classified as “fair.” Five cases with recurrence were rated “poor.” Preoperative and postoperative (5 years follow-up) related nerve root function status was compared. Sensation and muscle strength recovered significantly (P < 0.01), while tendon reflex was not changed (P = 0.782). No patients had infections. Five patients were complicated with dysesthesia in distribution of the exiting nerve that was all operated at L5-S1. Complaints were reduced one week after treatment with medium frequency pulse electrotherapy. Five cases required a revision surgery after recurrence. Limitations: This is an observational clinical case series study without comparison. Cohort Study Modified Percutaneous Lumbar Foraminoplasty and Percutaneous Endoscopic Lumbar Discectomy: Instrument Design, Technique Notes, and 5 Years Follow-up From: The First Affiliated Hospital of Chinese PLA’s General Hospital Beijing, China Address Correspondence: Zhen-zhou Li, M.D. Associate Chief Surgeon The First Affiliated Hospital of Chinese PLA’s General Hospital, Department of Orthopedic Surgery No. 51, Fucheng Road Haidian district Beijing, Beijing 100048 China 86 1068989322 E-mail: [email protected] Disclaimer: There was no external funding in the preparation of this manuscript. Conflict of interest: Each author certifies that he or she, or a member of his or her immediate family, has no commercial association (i.e., consultancies, stock ownership, equity interest, patent/licensing arrangements, etc.) that might pose a conflict of interest in connection with the submitted manuscript. Manuscript received: 08-10-2015 Revised manuscript received: 12-28-2015 Accepted for publication: 03-28-2015 Free full manuscript: www.painphysicianjournal. com Zhen-zhou Li, MD, Shu-xun Hou, MD, Wei-lin Shang, MD, Ke-ran Song, MD, and Hong-liang Zhao, MD www.painphysicianjournal.com Pain Physician 2017; 20:E85-E98 • ISSN 2150-1149 Conclusion: Modified PLF-PELD with a specially designed instrument is a less invasive, effective and safe surgery for complex uncontained lumbar DH. Key words: Lumbar disc herniation, minimally invasive treatment, foraminoplasty, percutaneous endoscopic lumbar discectomy

A172 EFFECT OF NERVE ROOT INFILTRATION ON THE RADICULAR BLOOD FLOW AFTER LUMBAR DISCECTOMY

1997 ◽  
Vol 87 (Supplement) ◽  
pp. 172A
Author(s):  
M. Fukusaki ◽  
M. Miyako ◽  
T. Hara ◽  
T. Nakamura ◽  
K. Sumikawa
Keyword(s):  
Blood Flow ◽  
Nerve Root ◽  
Lumbar Discectomy

Microsurgical Lumbar Discectomy

Neurosurgery ◽  
1979 ◽  
Vol 4 (2) ◽  
pp. 137-140 ◽  
Author(s):  
Donald H. Wilson ◽  
James Kenning
Keyword(s):  
Nerve Root ◽  
Lumbar Disc ◽  
Lumbar Discectomy ◽  
Normal Anatomy ◽  
Short Term ◽  
Common Cause ◽  
Microsurgical Technique ◽  
Epidural Fat

Abstract The application of microsurgical technique to lumbar discectomy may be of dual value: minimal disruption of the integrity of normal anatomy and meticulous hemostasis may help to speed the process of convalescence, and the retention of epidural fat around the nerve root may help to prevent adhesions, a common cause of the late, “failed disc” syndrome. The authors report their experience with 83 consecutive microdiscectomies for lumbar disc protrusions. The results must be considered as tentative because the follow-up period has been short and the authors found it difficult to quantify the quality of health during the convalescent phase, although this seemed to be excellent. Their short term results are similar to those of the larger series reported by Williams, whose experience with microsurgical lumbar discectomies began 6 years ago. No other series have been reported. The authors describe their technique and compare it to that of Williams.

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