Conjoined lumbosacral nerve roots compromised by disk herniation: sagittal shoulder sign for the preoperative diagnosis |
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Authors: | Chang Ho Kang Myung Jin Shin Sung Moon Kim Sang Hoon Lee Hee Kyung Kim Jeong Ah Ryu Choon-Sung Lee Sam Soo Kim |
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Institution: | (1) Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 388-1 Poongnap-dong, Songpa-Ku, Seoul, South Korea;(2) Present address: Department of Radiology, Anam Hospital, Korea University College of Medicine, 126-1, 5-Ka, Anam-dong, Sungbuk-Ku, Seoul, South Korea;(3) Department of Orthopedic Surgery, University of Ulsan College of Medicine, Asan Medical Center, 388-1 Poongnap-dong, Songpa-Ku, Seoul, South Korea;(4) Department of Radiology, Kangwon National University College of Medicine, 17-1, Hyoja3-Dong, Chuncheon-Si, Kangwon, 200-947, South Korea |
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Abstract: | Objective The objective was to determine the importance of the “sagittal shoulder sign” on magnetic resonance (MR) images for the diagnosis
of conjoined lumbosacral nerve roots (CLNR) that are compromised by herniated disks.
Materials and methods Magnetic resonance images of 11 patients (6 men and 5 women; age range, 25–71 years; average age, 48.7 years) with surgically
proven CLNR, which was compromised by herniated disks, were retrospectively evaluated by two musculoskeletal radiologists.
MR images were evaluated for the presence or absence of the sagittal shoulder sign—a vertical structure connecting two consecutive
nerve roots and overlying disk on the sagittal MR images. The radiologists noted the type of accompanying disk herniation
and bony spinal canal changes, as well as other characteristic MR features of CLNR, the common passage of two consecutive
nerve roots through the neural foramen on axial MR images.
Results The sagittal shoulder sign was identified with a mean frequency of 90.9% by the two observers (in 10 of 11 patients). The
common passage of two consecutive nerve roots through the neural foramen on axial MR images was identified with a mean frequency
of 59.1% (in 7 and 6 out of 11 patients, by observers 1 and 2, respectively). Good interobserver agreement for the sagittal
shoulder sign was present (k = 0.621, p < 0.05).
Conclusion Observation of the sagittal shoulder sign may prove helpful for diagnosing CLNR in patients with disk herniation. In particular,
this sign appears to be useful when there is no evidence of CLNR on axial MR images. |
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Keywords: | Spinal nerve roots Lumbosacral region Abnormalities Intervertebral disk displacement Magnetic resonance imaging |
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