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NerveVIEW shows right L5 radiculopathy and informs surgery

Case Study
Tanji, Hajime Northern Fukushima Medical Center • Japan
Yabuki, Shoji, MD, DMSc Fukushima Medical University School of Medecine • Japan

Patient history

No abnormal findings were seen on routine MRI of this patient with lower limb pain.
X-ray radiculography was then performed, but the contrast agent became trapped in transit and the nerve could not be fully observed. The peripheral nerve root is not contrasted in the nerve root block (x-ray radiculography) at the suspected location.

MR examination

At Northern Fukushima Medical Center, the patient underwent spine MRI with 3D NerveVIEW on Achieva 3.0T dStream.

Images

Click on an image to enlarge
X-ray radiculography Axial T2W TSE at level L5/S1
X-ray radiculography
Axial T2W TSE at level L5/S1
Sagittal T2W TSE NerveVIEW MPR
Sagittal T2W TSE
NerveVIEW MPR
NerveVIEW MIP Surgical approach
NerveVIEW MIP
Surgical approach

Diagnosis and follow-up

NerveVIEW images show that the spinal nerve is discontinued at the periphery of the dorsal root ganglion of the right L5 nerve root, suggesting nerve compression there.
No other findings could explain the symptoms.

 

With a diagnosis of extraforaminal herniation, surgery was performed. Based on the findings using NerveVIEW, the surgeon decided to perform a hernia resection with a different, less invasive surgical approach from the outside of the multifidus muscle (B) instead of the usual approach (A).

 

During surgery, disc herniation outside the intervertebral foramina was confirmed. Hernia resection released pressure on the nerve root and the right lower limb pain disappeared.

 

Impact of 3D NerveVIEW in this case

MRI on Achieva 3.0T dStream with NerveVIEW shows compression of nerve root outside the right L5/S1. Because NerveVIEW helped to accurately identify the location of the causative disease, a surgical approach could be chosen that prevented the need to peel off the muscle unnecessarily.

 

 

Read more in

FieldStrength article: Direct visualization on the nerves can influence surgery descisions.

 

 

 

 

Results from case studies are not predictive of results in other cases. Results in other cases may vary.



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Sep 4, 2018

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Case Study
Achieva 3.0T dStream
dStream, L5, Lumbar spine, MR neurography, Nerve, nerve root, NerveVIEW, Neuro, neurosurgery, radiculopathy, Spine
 

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