2015 Young Investigator Award Winner

Abstract

2.

Kinetic DTI of the cervical spine: diffusivity changes in healthy subjects

“…It has to be taken into consideration that the degree of traction and/or compression may alter DTI measurements also in the periphery, for instance in the optic, ulnar, or sciatic nerves. Recently, cervical nerve root displacement and strain during upper limb neural tension testing has been confirmed in cadavers [27,28]. Thus, nerve root entrapment may alter quantitative DTI values not only by direct compression [29] but potentially also by nerve displacement and tension.…”

Foraminal Ligaments Tether Upper Cervical Nerve Roots: A Potential Cause of Postoperative C5 Palsy

“…Together, these FLs center the nerve root in the foramen, reducing friction, and improving blood flow and electrophysiological transmission. 15 16 17 18 19 20 21 35 36 37 38 39 The role of these cervical FLs in holding and maintaining the central position of the nerve roots in their respective foramen and the result of this tethering is highlighted by physiological studies showing a 70% decrease in action potential amplitude with only 6% nerve root strain and complete conduction block at 12% strain. 40 Moreover, blood flow is decreased at 8% strain and intraneural circulation ceases completely at 15%.…”

“…This cadaveric study has obvious, inherent limitations, and extrapolation to an in vivo patient scenario requires further translational study. As mentioned, given the dual function of the FL (harmful in the context of postoperative C5P, yet also potentially protective in preventing distal forces being transmitted proximally upon, for example, traction-avulsion injuries), 15 20 36 our anatomical results will require further investigation in an in vivo animal pilot study prior to clinical implementation. However, the results and the potential role of the FL in C5P highlighted in this study help to lay a foundation on which these studies may occur.…”

“…Posterior cervical decompression results in dorsal migration of the SC upon removal of the overlying compressive pathology. 2 7 10 Once the SC migrates posteriorly, it is plausible that the FL (comprised of both intraforaminal ligaments [IFL]connecting the perineurium to the periosteum and extraforaminal ligaments connecting the nerve sheath to the uncovertebral and facet joints) 15 16 17 18 19 20 21 also contribute to nerve root tethering resulting in a traction injury. Our aim here is to test this hypothesis by anatomically comparing the amount of C5 and C6 intraforaminal nerve root translation postcervical decompression that occurs both before and after release of the FL.…”

Femoral nerve excursion with knee and neck movements in supine, sitting and side-lying slump: An in vivo study using ultrasound imaging

“…Movement in the same direction was observed when the bedding of the femoral nerve was lengthened with knee flexion. Invasive strain measurements (Gilbert et al, 2007;Lohman et al, 2015) or elastography in vivo (Andrade et al, 2016) are required to further investigate the effect of neck movement on the biomechanics of the femoral nerve in Slump FEMORAL .…”