Spinal Shortening Surgery for Lumbosacral Nerve Bowstring Disease: A Surgical Technique
Summary
Lumbosacral nerve bowstring disease (LNBD) is a syndrome comprising a series of neurological symptoms caused by high axial tension of the lumbosacral nerve due to congenital, iatrogenic, and other factors. Here, we introduce a surgical technique for the treatment of LNBD through spinal shortening surgery.
Abstract
Lumbosacral nerve bowstring disease (LNBD) is a syndrome of neurological symptoms caused by differences in the development speed of lumbosacral bone tissue and nerve tissue, which result in a longitudinal stretch of the slow-growing nerve tissue. LNBD is usually caused by congenital factors and accompanied by other lumbosacral diseases, such as lumbar spinal stenosis, lumbar spondylolisthesis, and iatrogenic factors. The main symptoms of LNBD are lower extremity neurological symptoms and fecal dysfunction. The conservative treatment of LNBD includes rest, functional exercise, and drug therapy, but it usually fails to achieve satisfactory clinical results. Few studies have reported on the surgical treatment of LNBD. In this study, we used posterior lumbar interbody fusion (PLIF) to shorten the spine (0.6-0.8mm/segment). This reduced the axial tension of the lumbosacral nerves and relieved the patient’s neurological symptoms. We report on the case of a 45 year old male patient whose main symptoms were left lower extremity pain, decreased muscle strength, and hypoesthesia. The above symptoms were significantly relieved 6 months after surgery.
Introduction
Lumbosacral nerve bowstring disease (LNBD) comprises a series of symptoms associated with nerve damage. LNBD is caused by increased lumbosacral nerve tension due to congenital developmental factors, iatrogenic injury, and a variety of other reasons1. LNBD can also be accompanied by other lumbosacral diseases, such as lumbar disc herniation, spinal stenosis, lumbar spondylolisthesis, and scoliosis2. Previous studies have found that the lengthening of the nerve roots is accompanied by a decrease in their cross-sectional areas3,4. Electrophysiological monitoring has shown that the nerve conduction velocity gradually decreases and is eventually completely blocked as tension on the nerve root increases5. The physiological curvature of the human lumbosacral region is like a bow. Due to the increase in axial tension, the patient's dural sac and nerve roots resemble a bowstring; therefore, LNBD is also called bowstring disease1. The symptoms of lower back and leg pain worsen over time due to the increase in tension.
Physiological curvature of the spine caused by spinal surgery is also an important cause of LNBD6,7. Due to the lack of typical clinical symptoms and imaging manifestations for LNBD, it is underdiagnosed. According to the pathogenesis, LNBD can be classified into developmental bowstring disease and degenerative bowstring disease1. The disease usually has two peaks of incidence. The first peak is in adolescent children because patients at this age are in a stage of rapid growth and development, and the bone tissue of the spine grows faster than the nerve tissue, causing the nerve tissue to be stretched and the patient to become symptomatic. These patients usually present with varying degrees of lower back pain and lower extremity pain8,9. The second peak is in the elderly, when LNBD is usually accompanied by other lumbosacral diseases. Lumbosacral diseases (such as scoliosis, lumbar spondylolisthesis, or lumbar disc herniation) lead to increased nerve root tension, which may also be the cause of LNBD in the elderly10. Often, LNBD is overlooked, and only the lumbosacral diseases are treated. The symptoms in these patients are usually more severe and manifest as intractable lower back pain, foot drop, and bowel dysfunction11.
Conservative treatments for LNBD include drug therapy, bed rest, and physiotherapy 1. However, none of these treatment methods can fundamentally solve the high-tension state of the stretched nerve and usually cannot achieve the expected therapeutic effect12. Surgery is a promising and effective treatment for LNBD. Several osteotomies have been reported to shorten the spine in the treatment of LNBD, such as vertebrectomy and pedicle subtraction osteotomy (PSO)13,14,15. Posterior lumbar interbody fusion (PLIF) is a commonly used surgical technique for spinal surgeons and can be applied to different spinal diseases16. Compared with other surgical techniques, this technique is relatively simple, and most spinal surgeons can master this technique skillfully. PLIF has higher security and reduces the risk of damaging other tissues17.
Here, we introduce a surgical technique for the treatment of LNBD by modified PLIF. We report on the case of 45 year old male patient whose main symptoms were left lower extremity pain, decreased muscle strength, and hypoesthesia.
Protocol
Representative Results
Discussion
LNBD comprises a series of neurological symptoms caused by congenital or iatrogenic factors that lead to the traction of the lumbosacral nerve and excessive axial tension1. The clinical symptoms of LNBD are lower extremity neurological symptoms, which mainly manifest as pain, numbness, and weakness of the lower extremities. Severe patients may have perineal numbness and fecal dysfunction. The imaging of LNBD generally shows no extraneural tissue localization or compression. Nerve root sedimentatio…
Declarações
The authors have nothing to disclose.
Acknowledgements
No funding was used in this study.
Materials
| Bipolar electrocoagulation tweezers | Juan'en Medical Devices Co.Ltd | BZN-Q-B-S | 1.2*190 mm |
| Compressor | Qingniu | qjz887 | straight head, head width 9 |
| Compressor | Qingniu | qjz890 | forward bending 5 °, head width 9 |
| Curette | Qingniu | 20739.01 | 300*Ø9*5° |
| Disc shaver | Qingniu | qjz860 | small |
| Disc shaver | Qingniu | qjz861 | middle |
| Disc shaver | Qingniu | qjz862 | large |
| Double jointed forceps | SHINVA | 286920 | 240*8 mm |
| High frequency active electrodes | ZhongBangTianCheng | GD-BZ | GD-BZ-J1 |
| Laminectomy rongeur | Qingniu | 2054.03 | 220*3.0*130° |
| Laminectomy rongeur | Qingniu | 2058.03 | 220*5.0*130° |
| Pedicle probe | Qingniu | qjz866 | straight type, 2.0 |
| Pedicle screw | WEGO | 800386545 | 6.5*45 mm |
| Pedicle screw | WEGO | 800386550 | 6.5*50 mm |
| Pituitary rongeur | Qingniu | 2028.01 | 220×3.0 mm |
| Pituitary rongeur | Qingniu | 2028.02 | 220×3.0 mm |
| Retractor | Qingniu | qjz901 | large, double head |
| Retractor | Qingniu | qjz902 | small, double head |
| Rod | WEGO | 800386040 | 5.5*500 mm |
| Surgical drainage catheter set | BAINUS MEDICAL | SY-Fr16-C | 100-400 ml |
| Titanium cage | WEGO | 9051228 | 19*80 mm |
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