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Changes in Nerve Root Motion and Intraradicular Blood Flow During an Intraoperative Straight-Leg-Raising Test

Kobayashi, Shigeru, MD, PhD*; Shizu, Naoyuki, MD, PhD; Suzuki, Yoshihiko, MD, PhD; Asai, Takahiro, MD, PhD; Yoshizawa, Hidezo, MD, PhD

doi: 10.1097/01.BRS.0000067087.94398.35
Diagnostics
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Study Design. An intraoperative straight-leg-raising (SLR) test was conducted to investigate patients with lumbar disc herniation to observe the changes in intraradicular blood flow, which then were compared with the clinical features.

Objective. The legs of each patient were hung down from the operating table as a reverse SLR test during surgery, and intraradicular blood flow was measured.

Summary of Background Data. It is not known whether intraradicular blood flow changes during the SLR test in patients with lumbar disc herniation.

Methods. The subjects were 12 patients with lumbar disc herniation who underwent microdiscectomy. The patients were asked to adopt the prone position immediately before surgery, so that their legs hung down from the operating table. A reverse SLR test was performed to confirm the angle at which sciatica developed. During the operation, the nerve roots affected by the hernia were observed under a microscope. Then the needle sensor of a laser Doppler flow meter was inserted into each nerve root immediately above the hernia. The patient’s legs were allowed to hang down to the angle at which sciatica had occurred, and the change in intraradicular blood flow was measured. After removal of the hernia, a similar procedure was repeated, and intraradicular blood flow was measured again.

Results. Intraoperative microscopy showed that the hernia was adherent to the dura mater of the nerve roots in all patients. The intraoperative reverse SLR test showed that the hernia compressed the nerve roots, and that there was marked disturbance of gliding, which was reduced to only a few millimeters. During the test, intraradicular blood flow showed a sharp decrease at the angle that produced sciatica, which lasted for 1 minute. Intraradicular flow decreased by 40% to 98% (average, 70.6% ± 20.5%) in the L5 nerve root, and by 41% to 96% (average, 72.0% ± 22.9%) in the S1 nerve roots relative to the blood flow before the test. At 1 minute after completion of the test, intraradicular blood flow returned to the value obtained at baseline. After removal of the hernia, all thepatients showed smooth gliding of the nerve roots during the second intraoperative test, and there was no marked decrease in intraradicular blood flow.

Conclusions. This study demonstrated that the blood flow in the nerve root is reduced when the nerve root is compressed in vivo.

From the *Department of Orthopaedics and Rehabilitation Medicine, Fukui University School Of Medicine, Fukui, Japan; and the

†Department of Orthopedics, Fujita Health University School of Medicine, Aichi, Japan.

Acknowledgment date: April 22, 2002.

First revision date: July 1, 2002.

Second revision date: August 17, 2002.

Acceptance date: December 9, 2002.

The submitted manuscript does not contain information about medical devices or drugs.

No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article. This article received a 2001 Sofamor Danek Best Poster Award, International Society for the Study of the Lumbar Spine.

Address correspondence and reprint requests to Shigeru Kobayashi, MD, PhD, Department of Orthopaedics and Rehabilitation Medicine, Fukui University School of Medicine, Shimoaizuki 23, Matsuoka, Fukui, 910-1193, Japan; E-mail: kshigeru@f8.dion.ne.jp or shigeru.kobayashi@physiol.ox.ac.uk

© 2003 Lippincott Williams & Wilkins, Inc.