An Experimental Study of the Effects of Nerve Root Retraction on the Posterior Ramus

Abstract

Findings showed that posterior lumbar procedures, including retraction of paravertebral muscle, fenestration of the lamina, and retraction of the nerve root affect the posterior ramus. Excessive retraction of the nerve root has an especially disastrous effect on the posterior ramus. Such a violent maneuver within the spinal canal must be avoided.

Effects of nerve root retraction in lumbar discectomy

“…Nagayama and colleagues 2 demonstrated in rats that excessive retraction of lumbar nerve roots caused postoperative nerve root damage that could be observed in postoperative anatomical studies. 2 Matsui and colleagues 1 published a study of 31 patients undergoing lumbar discectomy; they described the intraoperative nerve root retraction pressure and corresponding perfusion of the compromised nerve root. The authors found that the length of time in which elevated nerve root pressure was applied produced an additional effect that increased postoperative neurological compromise.…”

“…Of consequence, the "timed force" exerted against the involved nerve root as it is retracted during decompressive surgery has attracted considerable attention. [1][2][3]5 Our study was designed to focus on the dynamics of such retraction.…”

Kirschner wire is more effective than the nerve root retractor in treating patients with disc herniation

“…Actually, the retraction injury of nerve roots and dura is a leading cause of the lower limb pain, numbness, weakness, and even the failure of back surgery [5][6][7]. Moreover, excessive retraction of the nerve root has an especially disastrous effect on the posterior ramus.…”

“…Moreover, excessive retraction of the nerve root has an especially disastrous effect on the posterior ramus. Thus, such a violent maneuver within the spinal canal must be avoided or reduced to the minimum [6], and how to avoid the intraoperative retraction injury is an important measure to assess the success of an intraspinal operation.…”

“…However, the old version of nerve root retractor once commonly used in clinic could cause nerve root injury due to various reasons including excessive traction [5,6]. At present, the ever widely used newstyle nerve root retractor such as the Love nerve root retractor has also not been recommended for its clinical use due to its complex structure and poor clinical utility [5].…”