Straight leg raising. Anatomical effects on the spinal nerve root without and with fusion.

Straight leg raising (SLR) is a useful clinical test to demonstrate an inflammatory compressive process across a spinal nerve root. Several previous studies have attempted to evaluate the effect of SLR on nerve root motion, but the exact direction and amount of this motion is still unclear. Components of the SLR test that have not been adequately addressed include the effect of SLR on the intact dural-nerve root system, motion of the nerve tissues as distinct from the dura, and nerve root strain. Separately, spinal fusion is occasionally used as an adjunct to discectomy to decrease instability and subsequent "nerve root irritation." The effect of a one-level fusion on in situ nerve root biomechanics, however, has not been evaluated. Ten fresh human cadavers underwent posterior lumbar laminectomies. Spinal nerve root motion was studied while a SLR maneuver was performed. Data was recorded photographically and statistically analyzed. The results were as follows: 1) SLR induced both linear motion (0.5-5 mm) and strain (2-4%) in spinal nerves L4, L5, and S1; 2) The dura moved less than the intrathecal nerve root at the pedicle and experienced more strain (P < .05). 3) The nerve roots moved laterally toward the pedicle and thus would move into a posterolaterally herniated disc. 4) Rigid anterior stabilization did not decrease nerve root motion or strain.