Lumbar and sacral radiculopathy

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Genetic testing

NCV/EMG

Laboratory

Imaging

Biopsy

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Sacral Drg
Fig. 6. Lumbar anatomy. a1 1. Intervertebral foramen, 2. Dorsal root ganglion, a2 Section at L4-level, b1 1. Mediolateral prolaps, 2. Lateral prolapse, 3. Median prolapse, b2, b3 1. Mediolateral prolapse, b4 2. Lateral prolapse, 3. Median prolapse

Fig. 7. Lumbar vertebrostenos-is. Note the disappearance of the spinal fluid in T2 weighted images A. Lateral view shows multiple sites with narrowing B

Lateral Prolapse

Fig. 8. Motor involvement following sacral herpes S 1 on the right side. The vesicles can no longer be seen. A Right sided gluteal weakness with loss of muscle definition on the right compared to the intact left side. B Discrete dry skin changes over the right half. C Note the skin over the plantar right foot, which appears to be wrinkled compared to left side (atrophy of the small foot muscles)

Atrophy Paraspinal Muscles Image

Anatomy

The nerve root foramina are formed by the pedicles of lumbar vertebrae, which are notched on their upper and lower surfaces. The notches of adjacent pedicles form the upper and lower margins of the nerve root foramina. The anterior borders are the intervertebral discs, and the posterior border is formed by the facet joint and the pedicles.

The spinal cord ends at vertebrum L1. The ventral and dorsal lumbar and sacral roots arise from the conus medullaris and bundle to form the cauda equina.

Lumbar roots run obliquely downward. The dorsal and ventral roots fuse as they enter the foramen. The dorsal root ganglia (DRG) lie within the foramen, although their position may vary. The root divides into ventral and dorsal rami. The lumbar ventral rami form the lumbar plexus (see Fig. ).

The sacral spinal nerves divide into rami within the vertebral canal. Each dorsal ramus emerges through a dorsal sacral foramen to supply lower paraspinal muscles and the skin of the sacral and medial gluteal area.

The cauda is enveloped by an arachnoid membrane, from which a sleeve extends to cover each nerve root. As it passes the foramen, the root is covered by a short sleeve of dura (the root pouch).

Autonomic fibers are contained within S2-4 fibers, within the pudendal nerve (which regulates bladder, rectum, anus, sexual function, and regional blood flow), and pelvic splanchnic nerves. Sympathetic innervation begins with the upper two (sometimes three) lumbar spinal nerves, and then enters the sympathetic chain. Postganglionic fibres are distributed in abdominal and pelvic structures. Patients with the most common radiculopathies (L5/S1) do not have signs of sympathetic dysfunction.

The nerve roots exit in relation to the vertebral column. The cord terminates at vertebral level L1/2; the remaining roots drop vertically downward to exit their respective foramina.

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Responses

  • mariam
    Where do lumbar ventral and dorsal roots join to exit the foramina?
    10 months ago

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