E1297. Spinal Nerve Roots: Embryology, and Anatomy to Aid Localize Compressive Neuropathy in Degenerative Spondylosis
  1. Pokhraj Suthar; Rush University Medical Center
  2. Surjith Vattoth; UAMS Medical Center
  3. Shehbaz Ansari; Rush University Medical Center
  4. Eric Basappa; Rush University Medical Center
  5. Miral Jhaveri; Rush University Medical Center
  6. Santhosh Gaddikeri; Rush University Medical Center
Degenerative disease of the lumbar spine is a significant cause of disability in the world. A meta-analysis published by Ravindra, et al. showed total of 266 million individuals (3.63%) worldwide were found to have degenerative spinal disease and low back pain annually. Age-related degenerative changes in the lumbar spine frequently cause spinal nerve and nerve root compression, which finally leads to severe pain and disability. Diagnosis of spinal nerve and nerve root compression is challenging because sometimes disc degenerative level and patients' spinal nerve root compression levels are not matching.

Educational Goals / Teaching Points
Exact clinical localization of spinal nerve root compression can be challenging as sometime disc degenerative level and patient’s symptoms may not match. Cervical and thoracic nerve roots exit at the same segmental levels without traversing segments whereas the lumbar and sacral nerve roots exit at the lower levels from their origins and hence demonstrate traversing segments. Degenerative disc disease can result in bulge or herniations (subsites: central, paracentral, subarticular, foraminal and extraforaminal). Nerve root impinged by the disc can be at the same level or inferior level depending on the affected spinal segmental level (cervicothoracic versus lumbosacral) and the subsite of disc herniation.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
Briefly describe the embryology and relevant anatomy of spinal nerve roots. Emphasis on traversing and exiting nerve roots and relation to the adjacent vertebral levels. Describing various subsites of disc herniations and simplifying the identification of nerve root impinged throughout the spine. Case examples depicting disc bulge, various subsites of herniations and nerve roots affected. Nerve compression in transitional lumbosacral anatomy, various rare variant of nerve roots like ectopic course and conjoint nerve root.

Through this exhibit, we intend to strategically discuss important MRI imaging findings and clinical applications in diagnosis of spinal nerve and nerve roots compression.