gms | German Medical Science

55. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e. V. (DGNC)
1. Joint Meeting mit der Ungarischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

25. bis 28.04.2004, Köln

Lumbar nerve root avulsion following trauma. The importance of balanced fast field echo MR imaging

Lumbosakrale Plexusavulsion: Bedeutung der Balanced Fast-Field-Echo-MR-Bildgebung

Meeting Abstract

  • corresponding author Franz-Josef Hans - Neurochirurgische Klinik, RWTH Aachen, Aachen
  • T. Krings - Neuroradiologische Klinik, RWTH Aachen, Aachen
  • M. H. T. Reinges - Neurochirurgische Klinik, RWTH Aachen, Aachen
  • R. Thiex - Neurochirurgische Klinik, RWTH Aachen, Aachen
  • A. Thron - Neuroradiologische Klinik, RWTH Aachen, Aachen
  • J. M. Gilsbach - Neurochirurgische Klinik, RWTH Aachen, Aachen

Deutsche Gesellschaft für Neurochirurgie. Ungarische Gesellschaft für Neurochirurgie. 55. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e.V. (DGNC), 1. Joint Meeting mit der Ungarischen Gesellschaft für Neurochirurgie. Köln, 25.-28.04.2004. Düsseldorf, Köln: German Medical Science; 2004. DocP 09.101

Die elektronische Version dieses Artikels ist vollständig und ist verfügbar unter: http://www.egms.de/de/meetings/dgnc2004/04dgnc0384.shtml

Veröffentlicht: 23. April 2004

© 2004 Hans et al.
Dieser Artikel ist ein Open Access-Artikel und steht unter den Creative Commons Lizenzbedingungen (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.de). Er darf vervielf&aauml;ltigt, verbreitet und &oauml;ffentlich zug&aauml;nglich gemacht werden, vorausgesetzt dass Autor und Quelle genannt werden.


Gliederung

Text

Objective

Lumbosacral nerve root avulsion following major trauma is a rare clinical entity. First described in 1955, only 42 cases have been reported, the majority of whom had associated lumbar or pelvic fractures. We report on a patient, who had suffered a traumatic hip dislocation without associated fractures during a motor vehicle accident and in whom recent advances of MR imaging helped in establishing the diagnosis and in delineation of pseudomeningoceles associated with the lumbosacral plexus avulsion.

Methods

A 42-year-old man was assessed at our institution for chronic neurogenic pain and paresthesias of the left lower limb. He had a history of a road traffic accident two years before presentation. Radiological examinations revealed a traumatic central hip dislocation without associated acetabular fracture. Neurological examination revealed a flaccid monoparesis of the left lower limb due to a lesion of the sciatic nerve. Since MR imaging revealed a lumbosacral plexus avulsion, his pain was attributed to chronic deafferentiation. At our institution we perfomed an MRI of the sciatic nerve, the lumbosacral plexus and the lower spine using a 1.5T Philips Gyroscan with the standard spinal synergy coil and routine sequences (STIR, T2 TSE, MR myelography). Besides that a balanced fast field echo sequence (bFFE) (FOV: 230x230mm, Matrix: 1024x1024, 1mm slice thickness, TR:22 ms, TE: 4.2 ms, FA 30°) was performed.

Results

MRI revealed left-sided pseudomenigoceles at the L5 and S1 nerve root sleeves that extended through the neuroforamina and along the expected extraforaminal course of the roots towards the lumbosacral trunk. The discontinuity of the left L5 and S1 roots and the empty pseudomeningoceles could be depicted well on the thin sectioned bFFE sequences. Secondary arachnopathic changes with associated intraspinal pseudomembranes were also visible.

Conclusions

With this technique a high signal and a substantial T2-like contrast is observed allowing for high contrast display of water and tissue. A high quantitative and visual contrast between cerebrospinal fluid, the nerve roots and the surrounding tissues can be obtained. Therefore the bFFE can be used for high quality depiction of the nerve roots, dural sleeves and arachnopathic changes such as intraspinal membranes.