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LetterLETTER TO THE EDITOR
Open Access

Proposed Unifying Classification Criteria for Spinal Nerve Root Variations

Vladimir N. Nikolenko, Alexey N. Shkarubo, Ekaterina Zmeeva and Mikhail Y. Sinelnikov
Ochsner Journal June 2021, 21 (2) 123-125; DOI: https://doi.org/10.31486/toj.21.0014
Vladimir N. Nikolenko
1Sechenov University, Moscow, Russian Federation
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Alexey N. Shkarubo
2Burdenko Neurosurgical Clinic, Moscow, Russian Federation
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Ekaterina Zmeeva
1Sechenov University, Moscow, Russian Federation
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Mikhail Y. Sinelnikov
1Sechenov University, Moscow, Russian Federation
3Research Institute of Human Morphology, Moscow, Russian Federation
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TO THE EDITOR

Existing classification systems for spinal nerve root anomalies are numerous and substantially different from one another. Spinal nerve root abnormalities are known to be congenital deformities1 and are perceived to be the result of incorrect migration of nerve fibers, causing structural and spatial disorganization.2-3 Spinal nerves are formed from the ventral and dorsal roots in the spinal canal.4 Advances in anatomic research have prompted updated classifications for anatomic variations, known pathologic conditions, and clinical impacts of spinal nerve roots. Stratification of knowledge of these variations and abnormalities is important to understand the pathologic changes associated with these conditions and can be achieved through formulating specific unification criteria within existing classification systems. Upon analysis of the existing, most-used classification systems, we propose unifying classification criteria.

In 1962, Cannon et al first identified the 3 most common variations of nerve root anomalies: conjoined Type I, anastomosed Type II, and transverse Type III.1-2 In 1982, Postacchini et al classified common spinal nerve root abnormalities into 5 different variations.3 In 1983, Neidre and MacNab expanded Cannon's classification based on the angle and positioning of root emergence.5 In 1984, Kadish and Simmons introduced a classification system based on anatomic and radiologic findings.6 Chotigavanich and Sawangnatra provided a unified classification in 1992.7 The most recent (2020) classification update can be attributed to Haviarová et al.8

All the classifications describe similar processes (Figure). Therefore, we propose a unified classification based on type of deformity and localization (Table).

Figure.
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Figure.

Schematic representation of unified spinal nerve root anomaly classifications.

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Table.

Existing Classifications of Spinal Nerve Root Anomalies Arranged by Unifying Criteria

Based on existing classification systems for spinal nerve root anomalies, certain unifying criteria can be extracted. Primarily, all classification systems focus on intradural and extradural anastomoses. Further, all classification systems include descriptions of different anastomotic pathologies (intradural anastomoses, extradural anastomoses) and spacing deformities (aberrant root, transverse root, conjoined roots, caudal root). As such, the unifying criteria for spinal nerve root variations can be separated into the 2 main groups of intradural and extradural, each of which has 2 types of pathologies: anastomotic deformities and spacing deformities (Table). We therefore propose 4 variation types: intradural anastomotic deformities, intradural spacing deformities, extradural anastomotic deformities, and extradural spacing deformities. These 4 variations include all previously classified pathology types and can serve as a unifying classification system. Such a unification is warranted by the significantly different existing classification systems that complicate data stratification, focused research, and reporting. The abundance of different diagnostic criteria is associated with certain diagnostic and clinical struggles. Medical science always strives toward unification, as it provides a substantial basis for further research.

  • ©2021 by the author(s); Creative Commons Attribution License (CC BY)

©2021 by the author(s); licensee Ochsner Journal, Ochsner Clinic Foundation, New Orleans, LA. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (creativecommons.org/licenses/by/4.0/legalcode) that permits unrestricted use, distribution, and reproduction in any medium, provided the original author(s) and source are credited.

REFERENCES

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    1. Schmidt CK,
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    3. Alonso F,
    4. et al.
    Nerve root anomalies: making sense of a complicated literature. Childs Nerv Syst. 2017;33(8):1261-1273. doi: 10.1007/s00381-017-3457-3
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    1. Cannon BW,
    2. Hunter SE,
    3. Picaza JA
    . Nerve-rootanomalies in lumbar-disc surgery. J Neurosurg. 1962;19:208-214. doi: 10.3171/jns.1962.19.3.0208
    OpenUrlCrossRefPubMed
  3. 3.↵
    1. Postacchini F,
    2. Urso S,
    3. Ferro L
    . Lumbosacral nerve-root anomalies. J Bone Joint Surg Am. 1982;64(5):721-729.
    OpenUrlAbstract/FREE Full Text
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    1. Hogan Q,
    2. Toth J
    . Anatomy of soft tissues of the spinal canal. Reg Anesth Pain Med. 1999;24(4):303-310.
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  5. 5.↵
    1. Neidre A,
    2. MacNab I
    . Anomalies of the lumbosacral nerve roots. Review of 16 cases and classification. Spine (Phila Pa 1976). 1983;8(3):294-299. doi: 10.1097/00007632-198304000-00010
    OpenUrlCrossRef
  6. 6.↵
    1. Kadish LJ,
    2. Simmons EH
    . Anomalies of the lumbosacral nerve roots. An anatomical investigation and myelographic study. J Bone Joint Surg Br. 1984;66(3):411-416. doi: 10.1302/0301-620X.66B3.6725353
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  7. 7.↵
    1. Chotigavanich C,
    2. Sawangnatra S
    . Anomalies of the lumbosacral nerve roots. An anatomic investigation. Clin Orthop Relat Res. 1992;(278):46-50.
  8. 8.↵
    1. Haviarová Z,
    2. Matejčík V,
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    . Extradural and intradural characteristics of the cervical nerve root anomalies. J Clin Neurosci. 2020;73:259-263. doi: 10.1016/j.jocn.2020.01.074
    OpenUrlCrossRef
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Proposed Unifying Classification Criteria for Spinal Nerve Root Variations
Vladimir N. Nikolenko, Alexey N. Shkarubo, Ekaterina Zmeeva, Mikhail Y. Sinelnikov
Ochsner Journal Jun 2021, 21 (2) 123-125; DOI: 10.31486/toj.21.0014

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Proposed Unifying Classification Criteria for Spinal Nerve Root Variations
Vladimir N. Nikolenko, Alexey N. Shkarubo, Ekaterina Zmeeva, Mikhail Y. Sinelnikov
Ochsner Journal Jun 2021, 21 (2) 123-125; DOI: 10.31486/toj.21.0014
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