Intraspinal intradural variations of nerve roots

Matejčı́k, Viktor; Haviarová, Zora; Šteňo, Andrej; Kuruc, Roman; Štěňo, Juraj

doi:10.1007/s00276-017-1903-2

Cited by 6 publications

(5 citation statements)

References 20 publications

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“…Anatomic research has highlighted the presence of prefixed and postfixed types of brachial and lumbosacral plexi and anatomic variations in the nerve roots 21–26 . The extensive innervation found in the present study along with the left-right asymmetric innervation may be reflective of these anatomic variations.…”

Section: Discussionmentioning

confidence: 47%

“…Anatomic research has highlighted the presence of prefixed and postfixed types of brachial and lumbosacral plexi and anatomic variations in the nerve roots. [21][22][23][24][25][26] The extensive innervation found in the present study along with the left-right asymmetric innervation may be reflective of these anatomic variations. The combination of MRI-based evaluation of anatomic variations with electrophysiological evaluation as in the present study may deepen our understanding in such cases.…”

Section: Diagnosticsmentioning

confidence: 54%

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Broad and Asymmetric Lower Extremity Myotomes

Hashimoto,

Murohashi,

Yamada

et al. 2023

Spine

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Study Design. Retrospective review of prospectively collected data.Objective. This study aimed to accurately map the lower extremity muscles innervated by the lumbar spinal roots by directly stimulating the spinal roots during surgery. Summary of Background Data. Innervation of the spinal roots in the lower extremities has been estimated by clinical studies, anatomic studies, and animal experiments. However, there have been discrepancies between studies. Moreover, there are no studies that have studied the laterality of lower limb innervation. Materials and Methods. In 73 patients with lumbar degenerative disease, a total of 147 spinal roots were electrically stimulated and the electromyographic response was recorded at the vastus medialis (VM), gluteus medius (GM), tibialis anterior (TA), biceps femoris (BF), and gastrocnemius (GC). The asymmetry index (AI) was obtained using the following equation to represent the leftright asymmetry in the compound muscle action potential (CMAP) amplitude. Paired t tests were used to compare CMAP amplitudes on the right and left sides. Differences in the AI among the same spinal root groups were determined using one-way analysis of variance.

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Section: Discussionmentioning

confidence: 47%

Section: Diagnosticsmentioning

confidence: 54%

Broad and Asymmetric Lower Extremity Myotomes

Hashimoto,

Murohashi,

Yamada

et al. 2023

Spine

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“…Thus, myotomes vary across patients and can be broader than commonly described. It is possible that this is mediated by anastomoses between nerve roots, 8,9 although it may also be mediated proximal to the nerve roots.…”

Section: Discussionmentioning

confidence: 99%

A broad and variable lumbosacral myotome map uncovered by foraminal nerve root stimulation

London

Birkenfeld

Thomas

et al. 2022

Journal of Neurosurgery: Spine

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OBJECTIVE The human myotome is fundamental to the diagnosis and treatment of neurological disorders. However, this map was largely constructed decades ago, and its breadth, variability, and reliability remain poorly described, limiting its practical use. METHODS The authors used a novel method to reconstruct the myotome map in patients (n = 42) undergoing placement of dorsal root ganglion electrodes for the treatment of chronic pain. They electrically stimulated nerve roots (n = 79) in the intervertebral foramina at T12–S1 and measured triggered electromyography responses. RESULTS L4 and L5 stimulation resulted in quadriceps muscle (62% and 33% of stimulations, respectively) and tibialis anterior (TA) muscle (25% and 67%, respectively) activation, while S1 stimulation resulted in gastrocnemius muscle activation (46%). However, L5 and S1 both resulted in abductor hallucis (AH) muscle activation (17% and 31%), L5 stimulation resulted in gastrocnemius muscle stimulation (42%), and S1 stimulation in TA muscle activation (38%). The authors also mapped the breadth of the myotome in individual patients, finding coactivation of adductor and quadriceps, quadriceps and TA, and TA and gastrocnemius muscles under L3, L4, and both L5 and S1 stimulation, respectively. While the AH muscle was commonly activated by S1 stimulation, this rarely occurred together with TA or gastrocnemius muscle activation. Other less common coactivations were also observed throughout T12–S1 stimulation. CONCLUSIONS The muscular innervation of the lumbosacral nerve roots varies significantly from the classic myotome map and between patients. Furthermore, in individual patients, each nerve root may innervate a broader range of muscles than is commonly assumed. This finding is important to prevent misdiagnosis of radicular pathologies.

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“…Furthermore, intradural and extradural anatomical variations of nerve roots in lumbar and sacral canal can result in unusual clinical picture of perianal pain without radiating leg pain. 12,13 Surgical decompression by laminectomy releases the thecal sac and decompresses the roots, leading to relief. The bladder nerves are more difficult to recover and may take several months depending on the severity of the symptoms and duration of compression prior to intervention.…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Perineal pain: Think beyond gynaecological reasons

Gupta

Nigam²

2018

Journal of Endometriosis and Pelvic Pain Disorders

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Introduction: Perineal pain is multifactorial in nature. Gynaecological consultation is the first point of contact in females with perineal pain for diagnosis and treatment. Case description: Three females above 60 years presented with non-radiating perineal pain and bladder disturbance. Magnetic resonance imaging revealed severe L5 S1 dural compression, which was released by posterior laminectomy. Patients felt relief in perineal pain, though bladder symptoms persisted for several months. Conclusion: Sacral roots compression leading to pain along pudendal nerve distribution may present with cauda equina symptoms with pain radiating to legs. Awareness of this condition can prevent the delay and lead to better prognosis after the surgery.

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Intraspinal intradural variations of nerve roots

Cited by 6 publications

References 20 publications

Broad and Asymmetric Lower Extremity Myotomes

Broad and Asymmetric Lower Extremity Myotomes

A broad and variable lumbosacral myotome map uncovered by foraminal nerve root stimulation

Perineal pain: Think beyond gynaecological reasons

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