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Stretch on the L5 nerve root in high-grade spondylolisthesis reduction
Jin Yang1,2, Zhiyu Peng1, Qingquan Kong1
11Department of Orthopedics Surgery, West China Hospital, Sichuan University; and.
Journal of Neurosurgery. Spine
|February 11, 2022
Summary
This study measured L5 nerve root (L5-NR) stretch during high-grade spondylolisthesis (HGS) reduction. Increased disc height and reduction significantly increased L5-NR tension, especially in HGS patients.
Area of Science:
- Spinal surgery
- Biomechanics
- Nerve injury research
Background:
- High-grade spondylolisthesis (HGS) reduction can cause L5 nerve root (L5-NR) injury.
- Previous understanding attributed this to nerve stretching, but direct measurements were lacking.
Purpose of the Study:
- To quantify L5-NR tension during simulated HGS reduction procedures.
- To investigate the impact of disc height and reduction extent on L5-NR stretch.
Main Methods:
- 3D printed L5 vertebrae and sacrum models from CT data of HGS and control patients.
- A custom apparatus simulated reduction (translation, angle correction) and measured L5-NR tension using rabbit sciatic nerves and sensors.
- Varied disc heights (0, 5, 10 mm) and reduction degrees (0-100%).
Main Results:
- L5-NR tension increased nonlinearly with disc height and reduction percentage in both groups.
- HGS patients experienced significantly higher L5-NR tension compared to controls at similar disc heights and reduction levels.
- Slip-angle correction (0° to -30°) resulted in a minor increase in L5-NR tension.
Conclusions:
- Increased disc height and reduction are significant contributors to L5-NR tension during HGS surgery.
- HGS patients exhibit greater L5-NR stretch under comparable surgical conditions.
- Findings highlight the biomechanical risks to the L5-NR in HGS reduction.
