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Shota Tamagawa, Takatoshi Okuda, Hidetoshi Nojiri, Tatsuya Sato, Rei Momomura, Yukoh Ohara, Takeshi Hara, and Muneaki Ishijima

due to the dorsal overhang of the closed posterior superior iliac spine and paravertebral muscle. 19–21 Moreover, previous reports have highlighted the complications of L5 nerve root injury when S1 pedicle screws were inserted anterolaterally. 22–24 Although some cadaveric studies have demonstrated the anatomical relationship between the lumbar pedicle and adjacent dural sac and nerve roots, 25–27 few reports have detailed the anatomy of the L5 nerve root in the pelvis. Previous reports have measured the distance from the sacroiliac joint to the L5 nerve root

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Ehsan Dowlati, Hepzibha Alexander, and Jean-Marc Voyadzis

cases of 3 patients with postoperative L5 nerve root injuries. An explanation of the anatomical basis of this injury based on current literature and recommendations to mitigate this complication are discussed. Summary of Cases A total of 352 ALIF procedures were performed at our institution from 2017 to 2019. Of the 352 procedures, 111 were stand-alone ALIFs at L5–S1 with no posterior instrumentation or fusion. Seven patients within this cohort were identified as having experienced symptomatic nerve root injuries within 60 days of surgery. Two patients had cage

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Shota Tamagawa, Takatoshi Okuda, Hidetoshi Nojiri, Rei Momomura, and Muneaki Ishijima

often used, in which the S1 pedicle screws penetrate the anterior sacral cortex to achieve greater stability than that achieved using the monocortical method. 6–9 Several reports have described the risk of neurovascular injury when S1 pedicle screws are inserted into the anteromedial side of the sacrum; 10–12 however, few reports have focused on the complications of an L5 nerve root injury when the screws are inserted anterolaterally. 13 , 14 In this study, we report the cases of two patients with postoperative L5 nerve root injury caused by anterolateral

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Masaaki Chazono, Ritsu Shiba, Hiroki Funasaki, Shigeru Soshi, Akira Hattori, and Katsuyuki Fujii

exposed the reddish brown—colored oval tumor that originated from the extradural L-5 nerve root. The entire L-5 root was sacrificed at the bifurcation of the dural sac, and all visible tumor was resected in pieces by using an ultrasonic aspirator. The total blood loss was approximately 1500 ml. One year postsurgery, the patient continued to experience no pain in her left leg and has fully recovered her muscle strength in the extensor hallucis longus; however, she does experience residual hypesthesia in her left lower extremity. Histopathological examination demonstrated

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Francesco Peia, Marco Gessi, Paola Collini, Andrea Ferrari, Alessandra Erbetta, and Laura G. Valentini

affected in fewer than 20% of cases. 11 Intraneural synovial sarcoma may arise in proximal or distal nerves of the limbs, or it may affect spinal nerve roots. Histologically, it does not differ from classic synovial sarcoma. More than 90% of all synovial sarcomas show a reciprocal translocation t(X:18)(p11:q11). This constitutes the molecular hallmark of the entity and is considered a useful tool for the diagnosis of synovial sarcoma in difficult cases. 27 We report a case of intraneural synovial sarcoma arising from the L-5 nerve root in a girl presenting with leg

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Joseph Maarrawi, Sandra Kobaiter-Maarrawi, Ismat Ghanem, Youssef Ali, Georges Aftimos, Nabil Okais, and Elie Samaha

bilaterally (see Motor Response Threshold Determination ) using the same protocol as before RF application and without any prior knowledge by the examiner as to which L-5 root belonged to the sham side. The rat was killed following ethical standards. The L-5 roots were gently harvested using microsurgical scissors with the aid of a microscope and sent for pathological examination (see Pathological Examination ). Motor Response Threshold Determination The MRT measurement was performed by monitoring the motor response following L-5 nerve root stimulation using a 0

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Seungcheol Lee, Ji Hoon Kang, Umesh Srikantha, Il-Tae Jang, and Sung-Hun Oh

by cranially angulating the tubular retractor. In cases of severe narrowing of the L5–S1 intertransverse space, or a steep inclination of the ala, this portion of the sacral ala can be drilled to gain better access to the deeper part of the ala adjacent to the disc space and L-5 nerve root. F ig . 4. Intraoperative photographs showing the sequential steps of exposure and decompression in a case of a ruptured disc on the left side. A: Image taken after initial drilling of the lateral facet. B: After drilling the lower transverse process, partial ligament

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Thomas H. K. Ng, Kwan Hon Chan, Kirpal S. Mann, and Ching F. Fung

intervertebral disc ( Fig. 1 left ). The cerebrospinal fluid was crystal-clear with no cells and normal biochemical results. Subsequent computerized tomography-metrizamide myelogram showed an intradural extramedullary space-occupying lesion at the T12-L1 level ( Fig. 1 center ). Fig. 1. Left: Myelogram showing a complete block at the level of the T12-L1 intervertebral disc. Center: Computerized tomography scan-metrizamide myelogram showing an intradural extramedullary lesion. Right: Operative photograph showing the tumor arising from the L-5 nerve root

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Bradley K. Weiner and John A. McCulloch

. All patients complained of leg pain that was significantly greater than back pain. Their history of leg pain was short in duration (generally < 6 months). Unilateral radicular pain was seen in all but one patient who had bilateral complaints. All patients had symptoms and physical findings localized to the L-5 nerve root, including decreased straight-leg raising, positive bow-string testing, dorsal foot sensory changes, and dorsiflexion weakness. None had signs or symptoms of bowel or bladder involvement. The extent of vertebral spondylolisthesis was documented

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Christoph P. Beier, Arndt Hartmann, Chris Woertgen, Alexander Brawanski, and Ralf D. Rothoerl

, and the intervertebral space was intact. All cultures remained sterile. The left lamina and the left facet joint were destroyed; the remaining bone was easily removed. The dura mater was intact without signs of erosion; however, the lesion was firmly adherent, with compression of the dura sac and the L-5 nerve root. Both lesions were decompressed and several biopsy samples were taken. Fig. 2. Intraoperative photograph of the open spinal canal after resection of parts of the left vertebral arch ( black arrow : gout tophus; white arrow : left vertebral arch