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2006 Young Investigator Award Winner: Lumbosacral Nerve Root Displacement and Strain: Part 1. A Novel Measurement Technique During Straight Leg Raise in Unembalmed Cadavers

Gilbert, Kerry K. PT, ScD*; Brismée, Jean-Michel PT, ScD*; Collins, Dwayne L. RN, BSN; James, C Roger PhD*; Shah, Rinoo V. MD; Sawyer, Steven F. PT, PhD*; Sizer, Phillip S. Jr PT, PhD*

doi: 10.1097/BRS.0b013e318067dd55
Clinical Case Series

Study Design. A descriptive cadaveric study incorporating a novel nerve root marking technique.

Objectives. To describe the displacement and strain of the lumbosacral nerve roots in the lateral recess during straight leg raise (SLR) without disrupting the foraminal ligaments.

Summary of Background Data. Previous studies document 2 to 8 mm of lumbosacral nerve root displacement during SLR. Prior dissection methods incorporated laminectomy and facetectomy.

Methods. Lower limbs and associated nerve roots of 5 unembalmed cadavers (n = 10) were studied. Metal markers were inserted intraneurally within the lateral recess of L4, L5, and S1 with a modified spinal needle. Fluoroscopic images were digitized to evaluate displacement and strain during SLR.

Results. The lumbosacral nerve roots in the lateral recess moved less and experienced less strain during SLR than described in previously published reports. Statistically significant distal displacement occurred at hip positions greater than 60° of flexion at all nerve root levels (P < 0.01).

Conclusions. The lumbosacral nerve roots (L4, L5, S1) moved less and underwent less strain during SLR testing than previously reported and may require hip motion greater than 60° to produce substantive displacement in the lateral recess. Additional research is needed to examine the effects of prepositioning during SLR.

This novel neural marking technique limited disruption of the foraminal root ligaments. Lumbosacral nerve roots in the lateral recess move less and undergo less strain than previously reported during straight leg raise (SLR) testing. Significant movement of the lumbosacral nerve roots in the lateral recess occurred with SLR after 60° of hip motion.

From the *Center for Rehabilitation Research and Department of Rehabilitation Sciences, Texas Tech University Health Sciences Center, Lubbock, TX; †Pain Management Clinic, Lubbock, TX; and ‡Guthrie Clinic, Section of Interventional Pain Medicine, Department of Anesthesiology, Sayre, PA.

Acknowledgment date: March 20, 2006. First revision date: July 5, 2006. Second revision date: September 8, 2006. Acceptance date: October 2, 2006.

Supported by the Texas Tech University Health Sciences Center, School of Allied Health Sciences.

The manuscript submitted does not contain information about medical device(s)/drug(s).

Institutional funds were received in support of this work. No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript.

Address correspondence and reprint requests to Kerry K. Gilbert, PT, ScD, Master of Physical Therapy Program, Department of Rehabilitation Sciences, School of Allied Health Sciences, Texas Tech University Health Sciences Center, 3601 4th Street, Rm 2B180, Lubbock, TX 79430; E-mail: kerry.gilbert@ttuhsc.edu

© 2007 Lippincott Williams & Wilkins, Inc.