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    Exiting Nerve Root Traversing Nerve Root

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    Muhammad Randi Akbar
    The document discusses diagnostic tests for sacroiliitis. Laboratory tests commonly show normal white blood cell counts but elevated erythrocyte sedimentation rate and C-reactive protein. Approximately 50-92% of patients with ankylosing spondylitis test positive for HLA-B27. Conventional pelvis radiography should be the initial imaging method. Computed tomography can detect structural lesions like erosions and sclerosis at later stages. Magnetic resonance imaging can detect inflammation in early stages before structural damage occurs.

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    Exiting Nerve Root Traversing Nerve Root

    Uploaded by

    Muhammad Randi Akbar
    11 views14 pages
    The document discusses diagnostic tests for sacroiliitis. Laboratory tests commonly show normal white blood cell counts but elevated erythrocyte sedimentation rate and C-reactive protein. Approximately 50-92% of patients with ankylosing spondylitis test positive for HLA-B27. Conventional pelvis radiography should be the initial imaging method. Computed tomography can detect structural lesions like erosions and sclerosis at later stages. Magnetic resonance imaging can detect inflammation in early stages before structural damage occurs.

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    The document discusses diagnostic tests for sacroiliitis. Laboratory tests commonly show normal white blood cell counts but elevated erythrocyte sedimentation rate and C-reactive protein. Approximately 50-92% of patients with ankylosing spondylitis test positive for HLA-B27. Conventional pelvis radiography should be the initial imaging method. Computed tomography can detect structural lesions like erosions and sclerosis at later stages. Magnetic resonance imaging can detect inflammation in early stages before structural damage occurs.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    11 views14 pages

    Exiting Nerve Root Traversing Nerve Root

    Uploaded by

    Muhammad Randi Akbar
    The document discusses diagnostic tests for sacroiliitis. Laboratory tests commonly show normal white blood cell counts but elevated erythrocyte sedimentation rate and C-reactive protein. Approximately 50-92% of patients with ankylosing spondylitis test positive for HLA-B27. Conventional pelvis radiography should be the initial imaging method. Computed tomography can detect structural lesions like erosions and sclerosis at later stages. Magnetic resonance imaging can detect inflammation in early stages before structural damage occurs.

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    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
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    of 14

    EXITING NERVE ROOT

    TRAVERSING NERVE ROOT


    Two Nerve Roots at Each Level

    Exiting nerve root


    The nerve root that exits the spine at a
    particular level is referred to as the
    “exiting” nerve root.
    • the one that has budded off the thecal sac
    and is on its way to and through the neural
    foramen
    • After its genesis, it will have the same
    number designation as the vertebral body,
    the disc it passes by, and the neural foramen
    it passes out of.
    Refference: Liounakos, J. I., & Wang, M. Y. (2020). The Endoscopic Approach to Lumbar Discectomy, Fusion, and Enhanced Recovery: A Review. Global Spine Journal, 10(2_suppl), 65S–69S.
    The exiting nerve root

    For example, the left L4 exiting nerve root


    will bud off the thecal sac at the mid-
    vertebral body level of L4, wrap
    underneath the left L4 pedicle, pass by
    the left posterolateral aspect of the L4
    disc, and proceed through the left L4
    neural foramen before transforming into
    the left L4 spinal nerve.

    Refference: Liounakos, J. I., & Wang, M. Y. (2020). The Endoscopic Approach to Lumbar Discectomy, Fusion, and Enhanced Recovery: A Review. Global Spine Journal, 10(2_suppl), 65S–69S.
    Two Nerve Roots at Each Level

    Traversing nerve root


    Another nerve root goes across the disc and
    exits the spine at the next level below. It is
    called the “traversing” nerve root.

    Refference: Liounakos, J. I., & Wang, M. Y. (2020). The Endoscopic Approach to Lumbar Discectomy, Fusion, and Enhanced Recovery: A Review. Global Spine Journal, 10(2_suppl), 65S–69S.
    The travering nerve root

    For example, at the L4 disc level, we


    already know there is a L4 exiting nerve
    root that passes the posterolateral disc
    on its way to the neural foramen. But
    there is also left L5 traversing nerve root
    positioned adjacent to the L4 disc (it is
    actually in a region of the central canal
    called the lateral recess); however, it is
    still within the thecal sac.

    Refference: Liounakos, J. I., & Wang, M. Y. (2020). The Endoscopic Approach to Lumbar Discectomy, Fusion, and Enhanced Recovery: A Review. Global Spine Journal, 10(2_suppl), 65S–69S.
    The S1 nerve root is an exception to this rule
    as it typically buds off the thecal sac earlier
    (more cephalad [toward the head]) than the rest
    of lumbar nerve roots and is already in nerve-
    root form when it passes the L5 disc.
    It makes the S1 nerve root particularly
    vulnerable to injury.

    Refference: Liounakos, J. I., & Wang, M. Y. (2020). The Endoscopic Approach to Lumbar Discectomy, Fusion, and Enhanced Recovery: A Review. Global Spine Journal, 10(2_suppl), 65S–69S.
    This exception to the rule is easy to
    prove by looking at a typical T1-
    weighted axial MRI image of the L5
    disc. In figure beside, the S1 nerve
    roots (yellow arrows) are outside of
    the thecal sac (pink star); a
    phenomena that is not typically seen
    at any other disc level—rarely you
    will see it at L4.
    Place Your Picture Here And Send To Back
    Pemeriksaan penunjang pada
    Sacroilitis
    Laboratory
    In most clinical evaluations, common laboratory findings
    in the aseptic setting include:

    • WBC count  usually normal (elevated in


    infection/septic presentation)
    • ESR  elevated
    • CRP  elevated
    • HLA-B27  About 50% to 92%% of patients with
    ankylosing spondylitis will be HLA-B27 positive
    • Rheumatoid Factor (RF)  Negative in the setting of
    true ankylosing spondylitis
    Refference: Buchanan BK, Varacallo M. Sacroiliitis. [Updated 2022 Sep 4]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK448141/
    Conventional radiography of sacroiliitis

    Evaluation of the sacroiliac


    joints should be with a
    conventional anteroposterior
    supine view of the pelvis and
    should be the first imaging
    method to diagnose sacroiliitis.

    Refference: Slobodin, G., Hussein, H., Rosner, I., & Eshed, I. (2018). Sacroiliitis - early diagnosis is key. Journal of inflammation research, 11, 339–344. https://doi.org/10.2147/JIR.S149494
    Computed tomography

    Structural lesions seen on CT develop


    at the later stage of sacroiliitis and
    include erosions, sclerosis, and
    ankylosis, of which erosions are the
    most sensitive and specific for the
    diagnosis of sacroiliitis 

    Refference: Slobodin, G., Hussein, H., Rosner, I., & Eshed, I. (2018). Sacroiliitis - early diagnosis is key. Journal of inflammation research, 11, 339–344. https://doi.org/10.2147/JIR.S149494
    MRI

    MRI has high contrast


    resolution, it is able to detect
    inflammation of the joints in
    its early stage before structural
    damage occurs

    Forty two year old male with ankylosing spondylitis.


    Refference: Slobodin, G., Hussein, H., Rosner, I., & Eshed, I. (2018). Sacroiliitis - early diagnosis is key. Journal of inflammation research, 11, 339–344. https://doi.org/10.2147/JIR.S149494
    Thanks

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