Intradural Repair of Lumbar Nerve Roots for Traumatic Paraparesis Leading to Functional Recovery

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Abstract

Study Design

Case report and a literature review of intradural nerve graft repair of traumatic lacerations of lumbar nerve roots.

Objective

Describe the technique and results of recent approach to the surgical management of traumatic lumbar nerve root injuries.

Summary of Background Data

Lumbar nerve root injuries are associated with a poor prognosis in terms of neurologic recovery and are generally managed conservatively. Animal studies and previous attempts at nerve root repair at both the level of the cervical and lumbar spine have demonstrated that some neurologic recovery is possible with the use of such methods.

Methods

The management of a 29-year-old man who sustained a traumatic fracture of his second lumbar vertebra resulting in the lacerations of his right second and third lumbar nerve roots with associated neurologic deficits is presented. The technique of nerve root repair is described with the outcome assessed by means of clinical examination, magnetic resonance imaging, and electromyography.

Results

At 8 years' clinical examination showed an absence of power in extension of his right knee with a complete recovery of motor function in hip flexion on the right side. Electromyography confirmed the clinical findings by demonstrating reinnervation of the right iliopsoas muscle.

Conclusions

This case describes a surgical approach to the management of traumatic lumbar nerve root injuries that offers the possibility of neurologic recovery and challenges the traditional approach of conservative management.

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