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Morphologic Changes of L5 Root at Coronal Source Images of MR Myelography in Cases of Foraminal or Extraforaminal Compression

  • Kim, Soo-Beom (Departments of Orthopedic Surgery, Seoul Wooridul Hospital) ;
  • Jang, Jee-Soo (Departments of Neurosurgery, Seoul Wooridul Hospital) ;
  • Lee, Sang-Ho (Department of Neurosurgery, Wooridul Spine Hospital)
  • 발행 : 2009.07.31

초록

Objective: Two findings easily found at coronal source images of MR myelography (MRM) were evaluated : dorsal root ganglion (DRG) swelling and running course abnormality (RCA) of L5 exiting root at foramen or extraforamen. We tried to find the sensitivity of each finding when root was compressed. Methods: From 2004 July to 2006, one hundred and ten patients underwent one side paraspinal decompression for their L5 root foraminal or extraforaminal compression at L5-S1 level. All kinds of conservative treatments failed to improve leg symptom for several months. Before surgery, MRI, CT and MRM were done. Retrospective radiologic analysis for their preoperative MRM coronal source images was done to specify root compression sites and L5 root morphologic changes. Results: DRG swelling was found in 66 (60%) of 110 patients. DRG swelling has statistically valuable meaning in foraminal root compression (chi-square test, p<0.0001). Seventy-two (66%) in 110 patients showed abnormal alteration of running course. Abnormal running course has statistically valuable meaning in foraminal or extraforaminal root compression (chi-square test, p<0.0001). Conclusion: Three-dimensional MRM provides precise thin sliced coronal images which are most close to real operative views. DRG swelling and running course abnormality of L5 exiting root are two useful findings in diagnosing L5 root compression at L5-S1 foramen or extraforamen. MRM is thought to provide additional diagnostic accuracy expecially in L5-S1 foraminal and extraforaminal area.

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참고문헌

  1. Aota Y, Niwa T, Yoshikawa K, Fujiwara A, Asada T, Saito T : Magnetic resonance imaging and magnetic resonance myelography in the presurgical diagnosis of lumbar foraminal stenosis. Spine 32 : 896-903, 2007 https://doi.org/10.1097/01.brs.0000259809.75760.d5
  2. Burton CV, Kirkaldy-Willis WH, Yong-Hing K, Heithoff KB : Causes of failure of surgery on the lumbar spine. Clin Orthop Relat Res : 191-199, 1981
  3. Ebraheim NA, Xu R, Huntoon M, Yeasting RA : Location of the extraforaminal lumbar nerve roots. An anatomic study. Clin Orthop Relat Res : 230-235, 1997
  4. Hennig J, Friedburg H, Str$\ddot{o}$bel B : Rapid nontomographic approach to MR myelography without contrast agents. J Comput Assist Tomogr 10 : 375-378, 1986
  5. Matsumoto M, Chiba K, Nojiri K, Ishikawa M, Toyama Y, Nishikawa Y : Extraforaminal entrapment of the fifth lumbar spinal nerve by osteophytes of the lumbosacral spine : anatomic study and a report of four cases. Spine 27 : E169-E173, 2002 https://doi.org/10.1097/00007632-200203150-00020
  6. Moro T, Kikuchi S, Konno S, Yaginuma H : An anatomic study of the lumbar plexus with respect to retroperitoneal endoscopic surgery. Spine 28 : 423-428; discussion 427-428, 2003 https://doi.org/10.1097/00007632-200303010-00002
  7. Murata Y, Rydevik B, Takahashi K, Larsson K, Olmarker K : Incision of the intervertebral disc induces disintegration and increases permeability of the dorsal root ganglion capsule. Spine 30 : 1712-1716, 2005 https://doi.org/10.1097/01.brs.0000172231.11296.13
  8. Nathan H, Weizenbluth M, Halperin N : The lumbosacral ligament (LSL), with special emphasis on the 'umbosacral tunnel' and the entrapment of the 5th lumbar nerve. Int Orthop 6 : 197-202, 1982 https://doi.org/10.1007/BF00267730
  9. Olmarker K, Larsson K : Tumor necrosis factor alpha and nucleuspulposus-induced nerve root injury. Spine 23 : 2538-2544, 1998 https://doi.org/10.1097/00007632-199812010-00008
  10. Olmarker K, Rydevik B, Holm S : Edema formation in spinal nerve roots induced by experimental, graded compression. An experimental study on the pig cauda equina with special reference to differences in effects between rapid and slow onset of compression. Spine 14 : 569-573, 1989 https://doi.org/10.1097/00007632-198906000-00003
  11. Olsewski JM, Simmons EH, Kallen FC, Mendel FC : Evidence from cadavers suggestive of entrapment of fifth lumbar spinal nerves by lumbosacral ligaments. Spine 16 : 336-347, 1991 https://doi.org/10.1097/00007632-199103000-00014
  12. Ramsbacher J, Schilling AM, Wolf KJ, Brock M : Magnetic resonance myelography (MRM) as a spinal examination technique. Acta Neurochir (Wien) 139 : 1080-1084, 1997 https://doi.org/10.1007/BF01411564
  13. Sato K, Kikuchi S : An anatomic study of foraminal nerve root lesions in the lumbar spine. Spine 18 : 2246-2251, 1993 https://doi.org/10.1097/00007632-199311000-00017
  14. Segnarbieux F, Van de Kelft E, Candon E, Bitoun J, Fr$\grave{e}$rebeau P : Disco-computed tomography in extraforaminal and foraminal lumbar disc herniation : influence on surgical approaches. Neurosurgery 34 : 643-647; discussion 648, 1994 https://doi.org/10.1227/00006123-199404000-00011
  15. Shen J, Wang HY, Chen JY, Liang BL : Morphologic analysis of normal human lumbar dorsal root ganglion by 3D MR imaging. AJNR Am J Neuroradiol 27 : 2098-2103, 2006
  16. Wiltse LL, Guyer RD, Spencer CW, Glenn WV, Porter IS : Alar transverse process impingement of the L5 spinal nerve : the far-out syndrome. Spine 9 : 31-41, 1984 https://doi.org/10.1097/00007632-198401000-00008

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