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LETTER TO THE EDITOR
Year : 2016  |  Volume : 2  |  Issue : 1  |  Page : 60-61

Anomalous anterior and posterior nerve root openings


Department of Neurosurgery, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India

Date of Web Publication10-Aug-2016

Correspondence Address:
Aniruddh Kumar Purohit
Department of Neurosurgery, Nizam's Institute of Medical Sciences, Hyderabad, Telangana
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2395-4264.188169

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How to cite this article:
Pelluru PK, Purohit AK. Anomalous anterior and posterior nerve root openings. Indian J Cereb Palsy 2016;2:60-1

How to cite this URL:
Pelluru PK, Purohit AK. Anomalous anterior and posterior nerve root openings. Indian J Cereb Palsy [serial online] 2016 [cited 2017 May 26];2:60-1. Available from: http://www.ijcpjournal.org/text.asp?2016/2/1/60/188169

Sir,

Normally, both anterior and posterior spinal nerve roots run together in cauda equina and pass through a single opening in the thecal sac with its dural-arachnoid sleeve. They pass further remaining together through the corresponding intervertebral foramen [Figure 1]a and b. [1],[2],[3],[4] As an anomaly, two separate openings anterior and posterior nerve root in the thecal sac has not been published in English literature to the best of our knowledge.
Figure 1: Normal intradural course of anterior and posterior nerve roots at the cord (a) and cauda equina level (b)

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Here, we present a child with cerebral palsy who underwent selective posterior rhizotomy (SPR) which involves partial sectioning of the posterior nerve rootlets for reducing the hyperactive, myotatic, monosynaptic spinal reflex pathway so as to reduce spasticity. Interestingly, while identifying anterior and posterior nerve roots at the site of thecal openings, we found bilaterally the anterior and posterior nerve roots of both L5 and S1 were passing through separate openings in the thecal sac [Figure 2]. We could differentiate them on mechanical stimulation. The anterior roots alone showed muscle contractions. There were fibrous bands also on the right side between and around the anterior and posterior roots at S1 level.
Figure 2: Anterior and posterior nerve roots of S1 are seen passing through separate thecal openings and having fibrous bands. Operative microscope picture taken during selective posterior rhizotomy. (S=Sensory. M= Motor)

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Many different types of the root abnormalities have been described in literature. However, we found this new anomaly that has not been classified and reported so far. Operating surgeon should be aware of such an anomalous course of the nerve roots to correctly identify the root number (say S1 or L5) so as to avoid wrong level sectioning and also to avoid sectioning of anterior roots while performing SPR.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Crock HV. Normal and pathological anatomy of the lumbar spinal nerve root canals. J Bone Joint Surg Br 1981;63B: 487-90.  Back to cited text no. 1
    
2.
Cannon BW, Hunter SE, Picaza JA. Nerve-rootanomalies in lumbar-disc surgery. J Neurosurg 1962;19:208-14.  Back to cited text no. 2
    
3.
d'Avella D, Mingrino S. Microsurgical anatomy of lumbosacral spinal roots. J Neurosurg 1979;51:819-23.  Back to cited text no. 3
    
4.
Postacchini F, Urso S, Ferro L. Lumbosacral nerve-root anomalies. J Bone Joint Surg Am 1982;64:721-9.  Back to cited text no. 4
    


    Figures

  [Figure 1], [Figure 2]



 

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