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Lumbar nerve root biopsy with fascicle dissection and functional mapping: how I do it

  • How I Do it - Spine - Other
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Abstract

Background

Lumbosacral plexopathies with unclear etiology are a rare entity. In certain cases, if workup unrevealing and medical management is suboptimal, an open lumbar nerve root biopsy may be considered.

Method

A standard lumbar laminectomy is performed for access to the intradural contents. The dura is opened at midline in a standard fashion. Single nerve roots are selected and stimulated for an EMG response. A nerve fascicle is then dissected and stimulated before excision.

Conclusion

Lumbar nerve root biopsy is feasible and safe. All non-invasive workup needs to be completed and negative before performing this procedure.

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Author information

Authors and Affiliations

  1. Department of Neurosurgery, Mayo Clinic Florida, 4500 San Pablo Rd. S, Jacksonville, FL, 32224, USA

    Andres Ramos-Fresnedo, Oluwaseun O. Akinduro & Alfredo Quiñones-Hinojosa

  2. School of Medicine, Saint George’s University, Great River, NY, USA

    Gabriella A. Rivas

Authors
  1. Andres Ramos-Fresnedo
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  2. Gabriella A. Rivas
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  3. Oluwaseun O. Akinduro
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  4. Alfredo Quiñones-Hinojosa
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Corresponding author

Correspondence to Alfredo Quiñones-Hinojosa.

Ethics declarations

Ethical approval

All research and education activities for this manuscript were approved by the appropriate ethics committee and have therefore been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.

Informed consent

All patient information included has been deidentified and appropriate verbal and written consent for research and education was obtained prior to manuscript preparation.

Conflict of interest

The authors declare no competing interests.

Additional information

Key points

1. The cauda equina is the terminal end of the spinal cord and is located distal to the conus medullaris.

2. The cauda equina nerve roots are arranged in a lateral to medial and anterior to posterior manner.

3. The only indication for lumbar nerve root biopsy is if all other invasive and non-invasive workup has been exhausted.

4. Neuromonitoring with MEPs, SSEPs, and direct stimulation EMG is essential to reduce the risk of postoperative neurological deficits.

5. A positive control needs to be established before proceeding with the dissection.

6. Nerve roots need to be singled out and stimulated before dissection. If negative, a nerve fascicle is dissected and stimulated again. If negative, that fascicle can be excised.

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This article is part of the Topical Collection on Spine—Other

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Ramos-Fresnedo, A., Rivas, G.A., Akinduro, O.O. et al. Lumbar nerve root biopsy with fascicle dissection and functional mapping: how I do it. Acta Neurochir 164, 1895–1898 (2022). https://doi.org/10.1007/s00701-022-05209-7

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  • DOI: https://doi.org/10.1007/s00701-022-05209-7

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