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Lumbar nerve root biopsy with fascicle dissection and functional mapping: how I do it
Andres Ramos-Fresnedo1, Gabriella A Rivas2, Oluwaseun O Akinduro1
1Department of Neurosurgery, Mayo Clinic Florida, 4500 San Pablo Rd. S, Jacksonville, FL, 32224, USA.
Acta Neurochirurgica
|April 19, 2022
Summary
For rare lumbosacral plexopathies with unknown causes, an open lumbar nerve root biopsy is a viable option when other treatments fail. This surgical procedure is safe and feasible after all non-invasive evaluations are negative.
Area of Science:
- Neurology
- Neurosurgery
- Pathology
Background:
- Lumbosacral plexopathies with unclear etiology represent a rare clinical challenge.
- When diagnostic workup is unrevealing and medical management proves suboptimal, surgical intervention may be considered.
Purpose of the Study:
- To evaluate the feasibility and safety of open lumbar nerve root biopsy for diagnosing lumbosacral plexopathies of unclear etiology.
Main Methods:
- The procedure involves a standard lumbar laminectomy for intradural access.
- Following dural opening, individual nerve roots are selected and stimulated for electromyography (EMG) response.
- A nerve fascicle is then dissected and stimulated prior to excision for biopsy.
Main Results:
- Open lumbar nerve root biopsy is technically feasible.
- The procedure demonstrated safety in the evaluated cases.
Conclusions:
- Lumbar nerve root biopsy is a feasible and safe diagnostic tool for lumbosacral plexopathies when etiology remains unclear after comprehensive non-invasive workup.
- This invasive procedure should only be considered after all non-invasive diagnostic avenues have been exhausted and yielded negative results.
