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Vol. 17. Issue 1.
Pages 54-59 (January 2006)
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Vol. 17. Issue 1.
Pages 54-59 (January 2006)
Conjoined lumbosacral nerve roots: observations on three cases and review of the literature
Raices lumbares conjuntas: a proposito de tres casos y revision de la literatura
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1881
M. Artico
, S. Franchitto
Department of Human Physiology and Pharmacology V. Erspamer. University La Sapienza
S. Carloia*, M. Piacentini*, G. Ferretti*, M. Dazzi**, E. Bronzetti***
* Addolorata Hospital Division of Radiology. University La Sapienza. Rome. Italy
** Service of Neuroradiology. University La Sapienza. Rome. Italy
*** Department of Cardiovascular, Respiratory and Morphological Sciences. University La Sapienza. Rome. Italy
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Summary

Lumbosacral nerve root anomalies are a rare group of congenital anatomical anomalies. Various types of anomalies of the lumbosacral nerve roots have been documented in the available international literature. Generally speaking, these anomalies may consist of a bifid, conjoined structure, of a transverse course or of a characteristic anastomized appearance. Firstly described as an incidental finding during autopsies or surgical procedures performed for lumbar disk herniations and often asymptomatic, lumbosacral nerve root anomalies have been more frequently described in the last years due to the advances made in radiological diagnosis (metrizamide myelography and CT, MRI).

Our study comprised three patients with conjoined lumbosacral nerve roots, representing 0.25% of a total of 1200 patients who underwent lumbosacral CT/MRI procedures in the Addolorata Hospital and in the Service of Neuroradiology of the University of Rome “La Sapienza” during the last three years (March 2001-March 2004). We report our experience with three cases of conjoined lumbosacral nerve roots and analyze the most important literature on this topic.

MR imaging is a better diagnostic procedure (in comparison to CT) for the differentiation of nerve root anomalies and, in particular, coronal sections furnish a precise definition of the profile of the conjoined/enlarged rootlets. In fact, the accurate information derived from MRI of multiple planes may be priceless for the preoperative and diagnostic evaluation of lumbosacral nerve root anomalies.

Key words:
Lumbosacral nerve root anomalies
Conjoined nerve roots (CNR)
Spine
CT
MRI
Abreviaturas:
CT
MRI
RM
TAC
Resumen

Las anomalías congénitas de los nervios raquídeos lumbares no son muy frecuentes y suelen ser difíciles de detectar en TAC sin contraste. La raíces lumbares pueden ser conjuntas o bífidas y frecuentemente son descubiertas en las autopsias clínicas. Cursan habitualmente con dolor (episodios de lumbalgia y lumbociatalgia) y sin déficit motor ni sensitivo. Las raíces conjuntas frecuentemente se aprecian en la RM.

Presentamos tres casos de raíces lumbares conjuntas intervenidos en el Servicio de Radiología del Hospital Addolorata de Roma y en el Servicio de Neurorradiología del Hospital Universitario de Roma “La Sapienza” entre 2001 y 2004, representando 0.25% de todos los 1200 pacientes evaluados mediante TAC y RM, y revisamos los aspectos diagnósticos presentados en la literatura mundial.

La RM es, en muchas ocasiones, superior a la TAC simple en el diagnóstico de las anomalías de las raíces nerviosas; además la RM tiene la ventaja de los planos sagitales y coronales.

La visualización de la médula y la cola de caballo, sin necesidad de contraste intratecal, hace que la RM sea el examen ideal para identificar las raíces nerviosas conjuntas, ofreciendo una ventaja clara sobre la TAC.

Palabras clave:
Anomalías de los nervios raquídeos lumbares
Raíces lumbares conjuntas (RLC)
Columna vertebral
Tomografía Computarizada
Resonancia magnética

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