Conjoined lumbosacral nerve roots compromised by disk herniation: sagittal shoulder sign for the preoperative diagnosis
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SCIENTIFIC ARTICLE
Conjoined lumbosacral nerve roots compromised by disk herniation: sagittal shoulder sign for the preoperative diagnosis Chang Ho Kang & Myung Jin Shin & Sung Moon Kim & Sang Hoon Lee & Hee Kyung Kim & Jeong Ah Ryu & Choon-Sung Lee & Sam Soo Kim
Received: 31 August 2007 / Accepted: 28 October 2007 / Published online: 19 December 2007 # ISS 2007
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 C. H. Kang : M. J. Shin (*) : S. M. Kim : S. H. Lee : H. K. Kim : J. A. Ryu 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 e-mail: [email protected] C.-S. Lee Department of Orthopedic Surgery, University of Ulsan College of Medicine, Asan Medical Center, 388-1 Poongnap-dong, Songpa-Ku, Seoul, South Korea S. S. Kim Department of Radiology, Kangwon National University College of Medicine, 17-1, Hyoja3-Dong, Chuncheon-Si, Kangwon 200-947, South Korea Present address: C. H. Kang Department of Radiology, Anam Hospital, Korea University College of Medicine, 126-1, 5-Ka, Anam-dong, Sungbuk-Ku, Seoul, South Korea
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
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