Department of Neurosurgery, Tufts Medical Center, Tufts University School of Medicine, Boston, MA 02110, USA.
Neurosurg Focus. 2013 Aug;35(2):E9. doi: 10.3171/2013.2.FOCUS1349.
Lumbar nerve root anomalies are uncommon phenomena that must be recognized to avoid neural injury during surgery. The authors describe 2 cases of nerve root anomalies encountered during mini-open transforaminal lumbar interbody fusion (TLIF) surgery. One anomaly was a confluent variant not previously classified; the authors suggest that this variant be reflected in an amendment to the Neidre and Macnab classification system. They also propose strategies for identifying these anomalies and avoiding injury to anomalous nerve roots during TLIF surgery. Case 1 involved a 68-year-old woman with a 2-year history of neurogenic claudication. An MR image demonstrated L4-5 stenosis and spondylolisthesis and an L-4 nerve root that appeared unusually low in the neural foramen. During a mini-open TLIF procedure, a nerve root anomaly was seen. Six months after surgery this patient was free of neurogenic claudication. Case 2 involved a 60-year-old woman with a 1-year history of left L-4 radicular pain. Both MR and CT images demonstrated severe left L-4 foraminal stenosis and focal scoliosis. Before surgery, a nerve root anomaly was not detected, but during a unilateral mini-open TLIF procedure, a confluent nerve root was identified. Two years after surgery, this patient was free of radicular pain.
腰椎神经根异常是一种不常见的现象，在手术过程中必须识别，以避免神经损伤。作者描述了在微创经椎间孔腰椎体间融合术（TLIF）手术中遇到的 2 例神经根异常。一种异常是以前未分类的融合变异；作者建议在 Neidre 和 Macnab 分类系统的修订中反映这一变体。他们还提出了在 TLIF 手术中识别这些异常和避免异常神经根损伤的策略。病例 1 为一名 68 岁女性，有 2 年神经源性跛行病史。磁共振成像（MRI）显示 L4-5 狭窄和滑脱，L-4 神经根在神经孔中显得异常低。在微创 TLIF 手术过程中，发现了神经根异常。手术后 6 个月，该患者的神经源性跛行消失。病例 2 为一名 60 岁女性，有 1 年左侧 L-4 神经根痛病史。MRI 和 CT 图像均显示左侧 L-4 椎间孔严重狭窄和局灶性脊柱侧凸。术前未发现神经根异常，但在单侧微创 TLIF 手术中，发现了融合神经根。手术后 2 年，该患者的神经根痛消失。
