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Journal of the Neurological Sciences Nov 2017Pathological studies of early Guillain-Barré syndrome (GBS), defined as of 10days of disease onset, are scanty making it difficult to interpret the physiopathology of... (Review)
Review
Pathological studies of early Guillain-Barré syndrome (GBS), defined as of 10days of disease onset, are scanty making it difficult to interpret the physiopathology of clinical and electrophysiological features. In 1949, Webb Haymaker and James Kernohan reported 50 clinico-pathological studies of fatal GBS cases, 32 of them having died between days 2 and 10 after onset. They established that the brunt of initial lesions, consisting of endoneurial oedema interpreted as degenerative, relied on spinal nerves. That this oedema was inflammatory was soon thereafter recognized. Two decades later, however, the pathogenic role of endoneurial oedema was disputed. In experimental allergic neuritis, considered an animal model of GBS, the initial lesion appearing on day 4 post-inoculation is marked inflammatory oedema in the sciatic nerve and lumbosacral nerve roots. Additional detailed clinico-pathological studies corroborated that the appearance of epi-perineurium at the subarachnoid angle, where anterior and posterior roots join to form the spinal nerve, is a pathological hotspot in early GBS, there developing inflammatory oedema, incipient demyelination and endoneurial ischemic zones with axonal degeneration. Furthermore, nerve ultrasonography has demonstrated predominant spinal nerve changes in early GBS, either demyelinating or axonal. Other outstanding Haymaker and Kernohan's contributions were to clarify the complex nosology of the syndrome bringing under the same rubric Landry's paralysis, acute febrile polyneuritis and GBS, and critically analyzing GBS exclusion criteria by then prevailing. It is concluded that the authors' legacy remains as relevant as ever.
Topics: Guillain-Barre Syndrome; History, 19th Century; History, 20th Century; Humans; Spinal Nerves
PubMed: 29110997
DOI: 10.1016/j.jns.2017.09.017 -
World Neurosurgery Mar 2020The C1 spinal nerve is a fascinating anatomic structure owing to its wide range of variations. Throughout history, understanding of the cranial and spinal nerves has... (Review)
Review
The C1 spinal nerve is a fascinating anatomic structure owing to its wide range of variations. Throughout history, understanding of the cranial and spinal nerves has probably influenced the current conception of this nerve among anatomists. Located at the craniocervical junction, the C1 spinal nerve contributes to the motor innervation of deep cervical muscles through the cervical (anterior) and Cruveilhier's (posterior) plexuses. Sensory functions of this nerve are more enigmatic; despite investigations into its dorsal rootlets, a dorsal root ganglion, and the relationships between this nerve and adjacent cranial and spinal nerves, there is still no consensus regarding its true anatomy. In this article, we review the available literature and discuss some of the developmental models that could potentially explain the wide range of variations and functions of the C1 nerve.
Topics: Cervical Plexus; Humans; Spinal Nerves
PubMed: 31838236
DOI: 10.1016/j.wneu.2019.12.024 -
Journal of Clinical Neurophysiology :... Apr 2012H-reflexes have been used in the clinical neurophysiology laboratory for some time to assess patients with neuromuscular disorders. There are only a few reports for the... (Review)
Review
H-reflexes have been used in the clinical neurophysiology laboratory for some time to assess patients with neuromuscular disorders. There are only a few reports for the application of H-reflexes for intraoperative neurophysiologic monitoring. The goals of this article are to review the intraoperative neurophysiologic monitoring of spinal nerve root function with H-reflexes. The following will be reviewed: (1) Introduction to H-reflexes, (2) pathophysiology of spinal nerve root function, (3) neurophysiologic basis of H-reflexes, (4) gastrocnemius H-reflex, (5) flexor carpi radialis H-reflex, (6) anesthetic technique and research, and (7) intraoperative applications of H-reflexes. H-reflexes are single sweep real-time recordings that provide immediate feedback to the surgeon. They can be used to monitor not only sensory and motor spinal nerve root function but also peripheral sensory and motor nerves, plexus, and postsynaptic spinal cord gray matter function.
Topics: Animals; H-Reflex; Humans; Monitoring, Intraoperative; Spinal Nerves
PubMed: 22469676
DOI: 10.1097/WNP.0b013e31824ceec5 -
European Radiology Dec 2021To evaluate the role of Dixon T2-weighted water-fat separation technique in predicting the outcome of lumbar transforaminal epidural injections (TFESIs).
OBJECTIVES
To evaluate the role of Dixon T2-weighted water-fat separation technique in predicting the outcome of lumbar transforaminal epidural injections (TFESIs).
METHODS
Patients who underwent TFESI of a single spinal nerve within 3 months after magnetic resonance imaging (MRI) exam between August 2018 and April 2020 were identified. The patients were classified into positive or negative outcome groups based on the response to the TFESI procedure. Two musculoskeletal radiologists measured the signal intensity of the injected side spinal nerves, contralateral side spinal nerves, and subcutaneous fat on axial Dixon T2-weighted water-only images, and the diameter of spinal nerve on axial Dixon T2-weighted in-phase images of the pre-procedural MRI. The measured values of the injected side spinal nerves were compared between the two groups and with the contralateral side spinal nerve.
RESULTS
A total of 94 patients were included, 76 in the positive outcome group and 18 in the negative outcome group. The mean signal intensity and the nerve-to-fat signal ratio of the injected side spinal nerve were significantly higher in the positive outcome group than in the negative outcome group (793.78 vs. 679.19, p = 0.016; 4.21 vs. 3.28, p = 0.003). In the positive outcome group, the diameter of the spinal nerve was significantly higher on the injected side than on the contralateral side (6.91 mm vs. 6.37 mm, p = 0.016).
CONCLUSIONS
The mean signal intensity and the nerve-to-fat signal ratio of the spinal nerve on axial Dixon T2-weighted water-only images can help predict patient response to the TFESI.
KEY POINTS
• Applying the Dixon technique to lumbar spine MRI can help predict patient response to the TFESI procedure. • An increased nerve-to-fat signal ratio and mean spinal nerve signal intensity on axial Dixon T2-weighted water-only images predicted favorable TFESI outcomes.
Topics: Humans; Injections, Epidural; Lumbar Vertebrae; Magnetic Resonance Imaging; Spinal Nerves; Water
PubMed: 34132874
DOI: 10.1007/s00330-021-08119-x -
Turkish Neurosurgery 2019To seek the efficacy of selective spinal nerve blocks in the treatment of groin pain that are irresponsive to peripheral nerve blocks.
AIM
To seek the efficacy of selective spinal nerve blocks in the treatment of groin pain that are irresponsive to peripheral nerve blocks.
MATERIAL AND METHODS
This retrospective study comprised 17 patients with ilioinguinal, iliohypogastric, and genitofemoral neuralgias treated between 2017 and 2018.
RESULTS
All patients received diagnostic peripheral nerve blocks and/or TAP blocks with blind or ultrasound-guided techniques. Four patients had ineffectual peripheral nerve blocks, after which they underwent T12 and L1 selective spinal nerve blocks. All four patients had satisfactory results.
CONCLUSION
If distal peripheral nerve blocks are ineffective, an upper level nerve lesion, a lesion in the lumbar plexus or an L1 radiculopathy should be considered in ilioinguinal, iliohypogastric, and genitofemoral neuralgias. Upper level nerve blocks should be performed before deciding on surgery.
Topics: Adult; Anesthesia, Spinal; Autonomic Nerve Block; Female; Femoral Neuropathy; Humans; Lumbosacral Plexus; Male; Middle Aged; Neuralgia; Peripheral Nerves; Retrospective Studies; Spinal Nerves
PubMed: 30829381
DOI: 10.5137/1019-5149.JTN.23990-18.1 -
Pain Feb 2000
Review
Topics: Animals; Ligation; Pain; Spinal Nerves; Wounds and Injuries
PubMed: 10666515
DOI: 10.1016/s0304-3959(99)00309-7 -
Journal of Clinical Neurophysiology :... Apr 2012In addition to potential spinal cord injury, spinal surgery carries a risk of damage to spinal nerve roots, which could result in sensory or motor deficit. Both... (Review)
Review
In addition to potential spinal cord injury, spinal surgery carries a risk of damage to spinal nerve roots, which could result in sensory or motor deficit. Both spontaneous and triggered electromyography (sEMG and tEMG, respectively) have been employed to reduce the risk of these deficits. This article reviews the theory and best practice of electromyographic monitoring for spinal surgery, the evidence supporting its use for various types of spine surgery, and finally, suggestions for future directions to improve knowledge and advance electromyographic monitoring of spinal nerves.
Topics: Animals; Electromyography; Evoked Potentials, Motor; Evoked Potentials, Somatosensory; Humans; Monitoring, Intraoperative; Neurosurgical Procedures; Peripheral Nerve Injuries; Postoperative Complications; Spinal Nerve Roots; Spinal Nerves
PubMed: 22469677
DOI: 10.1097/WNP.0b013e31824cece6 -
Musculoskeletal Science & Practice Apr 2021Clinical research supports a combination of upper limb neurodynamic testing (ULNT) strategies to rule out upper limb and cervical neurogenic pathology; however,...
BACKGROUND
Clinical research supports a combination of upper limb neurodynamic testing (ULNT) strategies to rule out upper limb and cervical neurogenic pathology; however, knowledge of the biomechanical response of spinal nerves during ULNT is lacking for radial and ulnar nerve biases.
OBJECTIVE
To assess whether radial and ulnar nerve biased strategies of ULNT elicit significant displacement and strain of cervical spinal nerves.
STUDY DESIGN
Cross-sectional.
METHODS
Radiolucent markers were implanted into spinal nerves C5-C8 proximal and distal to the intervertebral foramen in nine unembalmed cadavers (six male; three female) age 80.1 ± 13.2 years. Fluoroscopic images were captured during ULNT with radial and ulnar nerve biases. Images at rest and maximum tension were digitized and displacement and strain were measured. All data were analyzed using one sample t-tests and a generalized linear mixed models approach.
RESULTS
Upper limb neurodynamic testing with radial nerve bias resulted in displacement (2.44-3.04 mm) and strain (7.99-11.98%) and ULNT with ulnar nerve bias resulted in displacement (2.16-4.41 mm) and strain (7.12 and 12.95%). Significant extraforaminal displacement occurred during radial and ulnar nerve biases for all spinal nerves (all P < 0.05) whereas significant strain occurred during ulnar nerve biases for all spinal nerves but only in C6-C8 during radial nerve bias.
CONCLUSION
Upper limb neurodynamic testing using both radial and ulnar nerve biases resulted in cervical spinal nerve displacement and strain. Such techniques could be used to tension load or mobilize or cervical spinal nerves to evaluate for pathology.
Topics: Aged, 80 and over; Bias; Cross-Sectional Studies; Female; Humans; Male; Radial Nerve; Ulnar Nerve; Upper Extremity
PubMed: 33513560
DOI: 10.1016/j.msksp.2021.102320 -
Pain Medicine (Malden, Mass.) Aug 2020Peripheral nerve stimulation provides targeted stimulation and pain relief within a specific nerve distribution. This technical case report provides a method to perform...
OBJECTIVE
Peripheral nerve stimulation provides targeted stimulation and pain relief within a specific nerve distribution. This technical case report provides a method to perform selective nerve root stimulation of thoracic and lumbar spinal nerves using ultrasonography.
METHODS
Ultrasound-guided peripheral nerve stimulation of thoracic and lumbar spinal nerves allows better visualization of soft tissue anatomy and planning of needle trajectory.
CONCLUSIONS
Ultrasound-guided peripheral nerve stimulation procedures may provide a safer method for neurostimulation lead placement when compared with fluoroscopic-guided techniques.
Topics: Humans; Peripheral Nerves; Spinal Nerves; Transcutaneous Electric Nerve Stimulation; Ultrasonography; Ultrasonography, Interventional
PubMed: 32804223
DOI: 10.1093/pm/pnaa166 -
Neuromodulation : Journal of the... Aug 2021With the development of percutaneously inserted devices, peripheral nerve stimulation (PNS) has been gaining attention within chronic pain literature as a less invasive...
OBJECTIVES
With the development of percutaneously inserted devices, peripheral nerve stimulation (PNS) has been gaining attention within chronic pain literature as a less invasive neurostimulation alternative to spinal column and dorsal root ganglion stimulation. A majority of current PNS literature focuses on targeting individual distal nerves to treat individual peripheral mononeuropathies, limiting its applications. This article discusses our experience treating dermatomal pain with neurostimulation without needing to access the epidural space by targeting the proximal spinal nerve with peripheral nerve stimulation under ultrasound-guidance.
MATERIALS AND METHODS
A temporary, percutaneous PNS was used to target the proximal spinal nerve in 11 patients to treat various dermatomal pain syndromes in patients seen in an outpatient chronic pain clinic. Four patients received stimulation targeting the lumbar spinal nerves and seven patient received stimulation targeting the cervical or thoracic spinal nerves.
RESULTS
The case series presents 11 cases of PNS of the proximal spinal nerve. Seven patients, including a majority of the patients with lumbar radiculopathy, had analgesia during PNS. Four patients, all of whom targeted the cervical or thoracic spinal nerves, did not receive analgesia from PNS.
CONCLUSION
PNS of the proximal spinal nerve may be an effective modality to treat dermatomal pain in patients who are not candidates for other therapies that require access to the epidural space. This technique was used to successfully treat lumbar radiculopathy, post-herpetic neuralgia, and complex regional pain syndrome.
Topics: Chronic Pain; Humans; Peripheral Nerves; Spinal Nerves; Transcutaneous Electric Nerve Stimulation; Ultrasonography; Ultrasonography, Interventional
PubMed: 33314509
DOI: 10.1111/ner.13334