Dermatomyotomal supply in patients with variations in the number of lumbar vertebrae

Clinical article

View More View Less
  • 1 Seidel-Klinik, Clinic for Rheumatology, Spinal Disorders and Neuromuscular Diseases, Bad Bellingen; and
  • 2 Department of Neurology, University Medical Center Freiburg, Germany
Restricted access

Purchase Now

USD  $45.00

Spine - 1 year subscription bundle (Individuals Only)

USD  $369.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $600.00
Print or Print + Online

Object

Variation in the number of lumbar vertebrae occurs in a small portion of the population. Either the fifth lumbar vertebra shows assimilation to the sacrum or the first sacral vertebra shows a lumbar configuration, resulting in 4 or 6 lumbar vertebrae, respectively. Etiologically, lumbar nerve root syndrome is diagnosed by comparing the anatomical level of the disc herniation to the compressed nerve root and to the pattern of the peripheral sensory and motor deficit. In case of a variation in the number of lumbar vertebrae, defining the lumbar nerve roots becomes difficult. Variations in the number of lumbar vertebrae make the landmarks (the twelfth rib and the first sacral vertebra) unreliable clues to define the nerve roots. The allocation of the clinically damaged segment to the spinal disorder seen in imaging studies is essential for differential diagnosis and spine surgery.

Methods

A retrospective study was conducted of clinical, electrophysiological, and imaging data among inpatients over a period of 21 months. Eight patients who had isolated monosegmental discogenic nerve root compression and a variation in the number of lumbar vertebrae were selected.

Results

Seven patients presented with 6 lumbar vertebrae, and 1 patient presented with 4 lumbar vertebrae and disc herniation on 1 of the 2 caudal levels. Compression of the second-to-last nerve root in patients with 6 lumbar vertebrae resulted either in clinical L-5 or S-1 syndrome, or a combination of both. Compression of the last caudal nerve root resulted in a clinical S-1 nerve root syndrome.

Conclusions

The findings suggest that the dermatomyotomal supply of the lumbosacral nerve roots can vary in patients with a variation in the number of lumbar vertebrae, and a meticulous clinical, radiological, and electrophysiological examination is essential.

Abbreviations used in this paper: AP = anteroposterior; EMG = electromyography.

Spine - 1 year subscription bundle (Individuals Only)

USD  $369.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $600.00

Contributor Notes

Address correspondence to: Michael Kottlors, M.D., Clinic for Rheumatology, Spinal Disorders, and Neuromuscular Diseases, Hebelweg 4, 79415 Bad Bellingen, Germany. email: mkottlors@mediclin.de.
  • 1

    Bischoff C: Neurography: late responses. Muscle Nerve 26:Suppl 11 S59S65, 2002

  • 2

    Bornstein PE, & Peterson RR: Numerical variation of the presacral vertebral column in three population groups in North America. Am J Phys Anthropol 25:139146, 1966

    • Search Google Scholar
    • Export Citation
  • 3

    Bressler EL: Numbering of lumbosacral transitional vertebrae on MRI. AJR Am J Roentgenol 188:W210W211, 2007

  • 4

    Castellvi AE, , Goldstein LA, & Chan DP: Lumbosacral transitional vertebrae and their relationship with lumbar extradural defects. Spine (Phila Pa 1976) 9:493495, 1984

    • Search Google Scholar
    • Export Citation
  • 5

    Chang HS, & Nakagawa H: Altered function of lumbar nerve roots in patients with transitional lumbosacral vertebrae. Spine (Phila Pa 1976) 29:16321635, 2004

    • Search Google Scholar
    • Export Citation
  • 6

    Dvorák J: Neurophysiologic tests in diagnosis of nerve root compression caused by disc herniation. Spine (Phila Pa 1976) 21:24 Suppl 39S44S, 1996

    • Search Google Scholar
    • Export Citation
  • 7

    Elster AD: Bertolotti's syndrome revisited. Transitional vertebrae of the lumbar spine. Spine (Phila Pa 1976) 14:13731377, 1989

  • 8

    Hahn PY, , Strobel JJ, & Hahn FJ: Verification of lumbosacral segments on MR images: identification of transitional vertebrae. Radiology 182:580581, 1992

    • Search Google Scholar
    • Export Citation
  • 9

    Hughes RJ, & Saifuddin A: Numbering of lumbosacral transitional vertebrae on MRI: role of the iliolumbar ligaments. AJR Am J Roentgenol 187:W59W65, 2006

    • Search Google Scholar
    • Export Citation
  • 10

    Kim YH, , Lee PB, , Lee CJ, , Lee SC, , Kim YC, & Huh J: Dermatome variation of lumbosacral nerve roots in patients with transitional lumbosacral vertebrae. Anesth Analg 106:12791283, 2008

    • Search Google Scholar
    • Export Citation
  • 11

    Kottlors M, & Glocker FX: Polysegmental innervation of the medial paraspinal lumbar muscles. Eur Spine J 17:300306, 2008

  • 12

    Luoma K, , Vehmas T, , Raininko R, , Luukkonen R, & Riihimäki H: Lumbosacral transitional vertebra: relation to disc degeneration and low back pain. Spine (Phila Pa 1976) 29:200205, 2004

    • Search Google Scholar
    • Export Citation
  • 13

    Marinacci AA: The use of electromyography in the differential diagnosis of lumbar herniated disks. Bull Los Angel Neuro Soc 23:6571, 1958

    • Search Google Scholar
    • Export Citation
  • 14

    McCulloch JA, & Waddell G: Variation of the lumbosacral myotomes with bony segmental anomalies. J Bone Joint Surg Br 62:475480, 1980

  • 15

    Postacchini F, , Urso S, & Ferro L: Lumbosacral nerve-root anomalies. J Bone Joint Surg Am 64:721729, 1982

  • 16

    Ralston MD, , Dykes TA, & Applebaum BI: Verification of lumbar vertebral bodies. Radiology 185:615616, 1992

  • 17

    Schliack H: [Clinical research on segmental innervation of the skin.]. Dtsch Med Wochenschr 85:21442152, 1960. (Ger)

  • 18

    Thage O: The myotomes L2–S2 in man. Acta Neurol Scand Suppl 13:241243, 1965

  • 19

    Troni W: The value and limits of the H reflex as a diagnostic tool in S1 root compression. Electromyogr Clin Neurophysiol 23:471480, 1983

    • Search Google Scholar
    • Export Citation
  • 20

    Webber RH: Some variations in the lumbar plexus of nerves in man. Acta Anat (Basel) 44:336345, 1961

  • 21

    Willis TA: The lumbo-sacral vertebral column in man: its stability of form and function. Am J Anat 32:95123, 1923

  • 22

    Young A, , Getty J, , Jackson A, , Kirwan E, , Sullivan M, & Parry CW: Variations in the pattern of muscle innervation by the L5 and S1 nerve roots. Spine (Phila Pa 1976) 8:616624, 1983

    • Search Google Scholar
    • Export Citation

Metrics

All Time Past Year Past 30 Days
Abstract Views 438 289 20
Full Text Views 95 8 0
PDF Downloads 101 8 0
EPUB Downloads 0 0 0