Browse > Article
http://dx.doi.org/10.3340/jkns.2009.46.1.11

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)
Publication Information
Journal of Korean Neurosurgical Society / v.46, no.1, 2009 , pp. 11-15 More about this Journal
Abstract
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.
Keywords
MR myelography; Foraminal or extraforaminal; Lumbar disc herniation;
Citations & Related Records

Times Cited By Web Of Science : 2  (Related Records In Web of Science)
Times Cited By SCOPUS : 2
연도 인용수 순위
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   DOI   ScienceOn
2 Olmarker K, Larsson K : Tumor necrosis factor alpha and nucleuspulposus-induced nerve root injury. Spine 23 : 2538-2544, 1998   DOI   PUBMED   ScienceOn
3 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   DOI   PUBMED   ScienceOn
4 Sato K, Kikuchi S : An anatomic study of foraminal nerve root lesions in the lumbar spine. Spine 18 : 2246-2251, 1993   DOI   PUBMED   ScienceOn
5 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   PUBMED
6 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   DOI   ScienceOn
7 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   DOI   ScienceOn
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   DOI   PUBMED
9 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   DOI   ScienceOn
10 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   PUBMED
11 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   PUBMED
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   DOI   ScienceOn
13 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   DOI   PUBMED   ScienceOn
14 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   DOI   ScienceOn
15 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   DOI   ScienceOn
16 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   PUBMED   ScienceOn