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Identification of abnormalities in the lumbar nerve tract using diffusion-weighted magnetic resonance neurography

  • Hiroaki Manabe
  • Toshinori SakaiEmail author
  • Ryo Miyagi
  • Fumitake Tezuka
  • Kazuta Yamashita
  • Yoichiro Takata
  • Koichi Sairyo
Original Article

Abstract

Introduction

Abnormalities of the lumbar nerve tract caused by congenital variations or high nerve root take-off angles are difficult to visualize. Diffusion-weighted magnetic resonance neurography (DW-MRN) has recently been introduced for imaging of the lumbosacral region. The aims of this study were to identify lumbar nerve tract abnormalities caused by congenital variation or a high nerve root take-off angle using DW-MRN and to assess the diagnostic value of this imaging modality.

Methods

A total of 573 magnetic resonance images from 575 patients (261 men, 314 women; mean age 58.5 years) with low back/leg pain were retrospectively analyzed. We classified congenital variations in the lumbar nerve roots using the Neidre and MacNab criteria and investigated nerve roots with a take-off angle of 60° or more.

Results and discussion

Congenital variations were identified in 8 patients (9 nerve roots, 1.6%). The most commonly identified variation was in the sacral nerve root (n = 5) followed by the L4 (n = 3) and L5 (n = 1) nerve roots. All variations identified were on the left side. There were 3 cases of type 1a variation, 1 of type 1b, 1 of type 2, and 4 of type 3. In total, 210 (36.6%) of the magnetic resonance images showed high nerve root take-off angles at the intervertebral foramen that was caused by disk herniation, spondylolisthesis, or osteophytes with degeneration. Patients with high nerve root take-off angles were significantly older than those without (P < 0.05).

Graphical abstract

These slides can be retrieved under Electronic Supplementary Material.

Keywords

MRI Diffusion-weighted magnetic resonance neurography Lumbar nerve Nerve root anomaly 

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Supplementary material

586_2018_5867_MOESM1_ESM.pptx (671 kb)
Supplementary material 1 (PPTX 670 kb)

References

  1. 1.
    Hoy D, March L, Brooks P, Blyth F, Woolf A, Bain C, Williams G, Smith E, Vos T, Barendregt J, Murray C, Burstein R, Buchbinder R (2014) The global burden of low back pain: estimates from the Global Burden of Disease 2010 study. Ann Rheum Dis 73:968–974.  https://doi.org/10.1136/annrheumdis-2013-204428 CrossRefGoogle Scholar
  2. 2.
    Classification of Chronic Pain (1986) Descriptions of chronic pain syndromes and definitions of pain terms. Prepared by the International Association for the Study of Pain, Subcommittee on Taxonomy. Pain Suppl 3:S1–S226Google Scholar
  3. 3.
    Ethelberg S, Riishede J (1952) Malformation of lumbar spinal roots and sheaths in the causation of low backache and sciatica. J Bone Joint Surg Br 34-B:442–446CrossRefGoogle Scholar
  4. 4.
    Oikawa Y, Eguchi Y, Watanabe A, Orita S, Yamauchi K, Suzuki M, Sakuma Y, Kubota G, Inage K, Sainoh T, Sato J, Fujimoto K, Koda M, Furuya T, Matsumoto K, Masuda Y, Aoki Y, Takahashi K, Ohtori S (2017) Anatomical evaluation of lumbar nerves using diffusion tensor imaging and implications of lateral decubitus for lateral transpsoas approach. Eur Spine J 26:2804–2810.  https://doi.org/10.1007/s00586-017-5082-y CrossRefGoogle Scholar
  5. 5.
    Eguchi Y, Ohtori S, Yamashita M, Yamauchi K, Suzuki M, Orita S, Kamoda H, Arai G, Ishikawa T, Miyagi M, Ochiai N, Kishida S, Inoue G, Masuda Y, Ochi S, Kikawa T, Toyone T, Takaso M, Aoki Y, Takahashi K (2011) Diffusion-weighted magnetic resonance imaging of symptomatic nerve root of patients with lumbar disk herniation. Neuroradiology 53:633–641.  https://doi.org/10.1007/s00234-010-0801-7 CrossRefGoogle Scholar
  6. 6.
    Reinhold M, Ederer C, Henninger B, Eberwein A, Kremser C (2015) Diffusion-weighted magnetic resonance imaging for the diagnosis of patients with lumbar nerve root entrapment syndromes: results from a pilot study. Eur Spine J 24:319–326.  https://doi.org/10.1007/s00586-014-3602-6 CrossRefGoogle Scholar
  7. 7.
    Eguchi Y, Kanamoto H, Oikawa Y, Suzuki M, Yamanaka H, Tamai H, Kobayashi T, Orita S, Yamauchi K, Suzuki M, Inage K, Aoki Y, Watanabe A, Furuya T, Koda M, Takahashi K, Ohtori S (2017) Recent advances in magnetic resonance neuroimaging of lumbar nerve to clinical applications: a review of clinical studies utilizing diffusion tensor imaging and diffusion-weighted magnetic resonance neurography. Spine Surg Relat Res 1:61–71.  https://doi.org/10.22603/ssrr.1.2016-0015 CrossRefGoogle Scholar
  8. 8.
    Neidre A, MacNab I (1983) Anomalies of the lumbosacral nerve roots. Review of 16 cases and classification. Spine 8:294–299CrossRefGoogle Scholar
  9. 9.
    Hasegawa T, Mikawa Y, Watanabe R, An HS (1996) Morphometric analysis of the lumbosacral nerve roots and dorsal root ganglia by magnetic resonance imaging. Spine 21:1005–1009CrossRefGoogle Scholar
  10. 10.
    Takahara T, Imai Y, Yamashita T, Yasuda S, Nasu S, Van Cauteren M (2004) Diffusion weighted whole body imaging with background body signal suppression (DWIBS): technical improvement using free breathing, STIR and high resolution 3D display. Radiat Med 22:275–282Google Scholar
  11. 11.
    Beaulieu C, Allen PS (1994) Determinants of anisotropic water diffusion in nerves. Magn Reson Med 31:394–400CrossRefGoogle Scholar
  12. 12.
    Martin Noguerol T, Barousse R, Socolovsky M, Luna A (2017) Quantitative magnetic resonance (MR) neurography for evaluation of peripheral nerves and plexus injuries. Quant Imaging Med Surg 7:398–421.  https://doi.org/10.21037/qims.2017.08.01 CrossRefGoogle Scholar
  13. 13.
    Chhabra A, Madhuranthakam AJ, Andreisek G (2018) Magnetic resonance neurography: current perspectives and literature review. Eur Radiol 28:698–707.  https://doi.org/10.1007/s00330-017-4976-8 CrossRefGoogle Scholar
  14. 14.
    Zagnoni C (1949) Reperto di un tipo non conosciuto di anastomosi nervosa delle radici spinali. Atti Soc Med-chir Padova 27:48–52Google Scholar
  15. 15.
    Cape H, Balaban DY, Moloney M (2015) Endovascular repair of arteriovenous fistula after microendoscopic discectomy and lamino-foraminotomy. Vascular 23:93–98.  https://doi.org/10.1177/1708538114529762 CrossRefGoogle Scholar
  16. 16.
    Kadish LJ, Simmons EH (1984) Anomalies of the lumbosacral nerve roots. An anatomical investigation and myelographic study. J Bone Joint Surg Br 66:411–416CrossRefGoogle Scholar
  17. 17.
    White JG 3rd, Strait TA, Binkley JR, Hunter SE (1982) Surgical treatment of 63 cases of conjoined nerve roots. J Neurosurg 56:114–117.  https://doi.org/10.3171/jns.1982.56.1.0114 CrossRefGoogle Scholar
  18. 18.
    Canton Kessely Y, Tine I, Gaye Sakho M, Mbaye M, Ali Meidal M, Traore Y, Diop AA, Sakho Y (2015) Diagnostic and therapeutic implications of conjoined nerve root anomalies: a senegalese study of three cases. Iran J Neurosurg 1:21–25.  https://doi.org/10.18869/acadpub.irjns.1.3.21 CrossRefGoogle Scholar
  19. 19.
    Postacchini F, Urso S, Ferro L (1982) Lumbosacral nerve-root anomalies. J Bone Joint Surg Am 64:721–729CrossRefGoogle Scholar
  20. 20.
    Artico M, Carloia S, Piacentini M, Ferretti G, Dazzi M, Franchitto S, Bronzetti E (2006) Conjoined lumbosacral nerve roots: observations on three cases and review of the literature. Neurocirugia 17:54–59CrossRefGoogle Scholar
  21. 21.
    Helms CA, Dorwart RH, Gray M (1982) The CT appearance of conjoined nerve roots and differentiation from a herniated nucleus pulposus. Radiology 144:803–807.  https://doi.org/10.1148/radiology.144.4.7111728 CrossRefGoogle Scholar
  22. 22.
    Taghipour M, Razmkon A, Hosseini K (2009) Conjoined lumbosacral nerve roots: analysis of cases diagnosed intraoperatively. J Spinal Disord Tech 22:413–416.  https://doi.org/10.1097/BSD.0b013e31818f00a0 CrossRefGoogle Scholar
  23. 23.
    Lotan R, Al-Rashdi A, Yee A, Finkelstein J (2010) Clinical features of conjoined lumbosacral nerve roots versus lumbar intervertebral disc herniations. Eur Spine J 19:1094–1098.  https://doi.org/10.1007/s00586-010-1329-6 CrossRefGoogle Scholar
  24. 24.
    Kunogi J, Hasue M (1991) Diagnosis and operative treatment of intraforaminal and extraforaminal nerve root compression. Spine 16:1312–1320CrossRefGoogle Scholar
  25. 25.
    Burton CV, Kirkaldy-Willis WH, Yong-Hing K, Heithoff KB (1981) Causes of failure of surgery on the lumbar spine. Clin Orthop Relat Res 157:191–199Google Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Hiroaki Manabe
    • 1
  • Toshinori Sakai
    • 1
    Email author
  • Ryo Miyagi
    • 1
  • Fumitake Tezuka
    • 1
  • Kazuta Yamashita
    • 1
  • Yoichiro Takata
    • 1
  • Koichi Sairyo
    • 1
  1. 1.Department of Orthopedics, Institute of Biomedical SciencesTokushima University Graduate SchoolTokushimaJapan

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