Bellier Alexandre, Latreche A, Tissot L, Robert Y, Chaffanjon P, Palombi O
Laboratoire d'Anatomie Des Alpes Francaises (LADAF), Faculty of Medicine, UFR de Médecine de Grenoble, Grenoble Alpes University, Domaine de la Merci, 38706, La Tronche Cedex, France.
Medical Evaluation Department, Grenoble Alpes University Hospital, Grenoble Cedex 9, France.
Surg Radiol Anat. 2018 Nov;40(11):1223-1230. doi: 10.1007/s00276-018-2084-3. Epub 2018 Aug 20.
The pain involved in the herniated discs could be generated by some mobility of the nerve roots during straight leg raising (SLR). SLR produces some movement of nerves, but the magnitude of this displacement needs to be thorough, that is why we have investigated lumbo-sacral nerve root displacement in the spinal canal during the passive straight leg raise (SLR).
Fourteen cadavers underwent laminectomy to mark the nerve roots of L2-S1 with lead balls. X-rays were taken during different movements imposed on the body: bilateral hip extension, left SLR then right and bilateral SLR. By superimposing these images two by two, the displacement of the nerve roots is quantified numerically during the various SLR maneuvers with respect to the reference position corresponding to the bilateral hip extension.
The median range of the different nerve root movements ranged from 0.10 to 0.51 cm (p < 0.05 except for the L2 root) when the left SLR is applied, from 0.26 to 0.48 cm (p < 0.05) with the right SLR and from 0.30 to 0.65 cm (p < 0.05) with a bilateral SLR. No statistically significant relationship was found between age and movement value.
The lumbo-sacral nerve roots in the spinal canal region move statistically significantly in response to the clinically applied SLR test, except for L2 root during the left SLR. This movement is symmetric and greater when a bilateral SLR is applied. These anatomical results are correlated with those observed empirically in clinical practice.
椎间盘突出所涉及的疼痛可能是由直腿抬高（SLR）过程中神经根的一些移动所产生的。SLR会引起神经的一些移动，但这种位移的幅度需要深入研究，这就是我们研究在被动直腿抬高（SLR）过程中椎管内腰骶神经根位移的原因。
对14具尸体进行椎板切除术，用铅球标记L2 - S1神经根。在对身体施加不同动作时拍摄X线片：双侧髋关节伸展、左直腿抬高然后右直腿抬高以及双侧直腿抬高。通过将这些图像两两叠加，在各种直腿抬高动作过程中，相对于与双侧髋关节伸展相对应的参考位置，对神经根的位移进行数值量化。
当进行左侧直腿抬高时，不同神经根移动的中位数范围为0.10至0.51厘米（除L2神经根外，p < 0.05）；右侧直腿抬高时为0.26至0.48厘米（p < 0.05）；双侧直腿抬高时为0.30至0.65厘米（p < 0.05）。未发现年龄与移动值之间存在统计学上的显著关系。
椎管区域的腰骶神经根在临床应用的直腿抬高试验中会发生具有统计学意义的移动，除了左侧直腿抬高时的L2神经根。这种移动是对称的，并且在进行双侧直腿抬高时更大。这些解剖学结果与临床实践中凭经验观察到的结果相关。
