Size of human lower thoracic and lumbosacral nerve roots

Background: Nerve root size may determine degree of blockade after epidural or spinal anesthesia, but good measures of this fundamental anatomic parameter have not been published. Models of subarachnoid anesthetic distribution have lacked valid cauda equina dimensions, In this study, the author sought to measure cross-section areas of anterior and posterior roots at different levels for basic anthropomorphic analysis. Methods: Samples from 12 adult autopsy subjects were obtained from roots at levels TG through S5. Cross-section area was determined by dividing the root sample weight by length and correcting for tissue density. Results: Roots were variably composed of as many as five easily separable independent strands. Areas of anterior roots are approximately half the area of posterior roots. On average, the largest anterior and posterior root is at S1, but this may occur at L3 through S2. There is a large degree of interindividual variability (e.g., range of posterior L5 root is 2.33-7.71 mm(2)). Conclusions: The large size of low lumbar and high sacral roots may cause resistance to anesthetic effects, whereas the smaller dimensions of the thoracic roots may facilitate neural blockade. The small size of the low sacral roots may, in part, explain selective neurotoxic damage of these fibers after subarachnoid injections. Interindividual variability in root sizes may contribute to lack of predictability in anesthetic response.