An evidence‐based approach to human dermatomes

Lee, M.W.L.; McPhee, R.W.; Stringer, Mark D.

doi:10.1002/ca.20636

Cited by 183 publications

(155 citation statements)

References 44 publications

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“…of the sensory scores were greatest in the T6-T9 sub-group, with T6 to T9 being the hardest dermatomes to localize accurately. 8 Third, the sensory ZPP was shown to have little or no prognostic value with respect to subsequent changes in level. This would be an expected consequence of an unreliable sensory scoring of the thoracic dermatomes, as any uncertainty would also undermine accurate characterization of the ZPP and reduce the prognostic value it might have.…”

Section: Discussionmentioning

confidence: 98%

“…Conversely, the T6-T9 sub-group showed a significant difference in four of the seven comparisons (B-12w, B-24w, B-48w and 4w-12w, as per the abbreviations given in the caption of Supplemenatary Table S1). The greater number of differences in the T6-T9 segments may be because the dermatomes are less clearly delineated at those levels, 8 creating more potential for variability in sensory scores when stimuli are not repeatedly applied in the same location. We also examined how changes in pin-prick and light touch sensory levels relate to changes in neurological level.…”

Section: Levelmentioning

confidence: 99%

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Characterization of neurological recovery following traumatic sensorimotor complete thoracic spinal cord injury

et al. 2010

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European Multicenter Study about Spinal Cord Injury (EM-SCI) Study GroupStudy design: Retrospective, longitudinal analysis of sensory, motor and functional outcomes from individuals with thoracic (T2-T12) sensorimotor complete spinal cord injury (SCI). Objectives: To characterize neurological changes over the first year after traumatic thoracic sensorimotor complete SCI. Methods: A dataset of 399 thoracic complete SCI subjects from the European Multi-center study about SCI (EMSCI) was examined for neurological level, sensory levels and sensory scores (pin-prick and light touch), lower extremity motor score (LEMS), ASIA Impairment Scale (AIS) grade, and Spinal Cord Independence Measure (SCIM) over the first year after SCI. Results: AIS grade conversions were limited. Sensory scores exhibited minimal mean change, but high variability in both rostral and caudal directions. Pin-prick and light touch sensory levels, as well as neurological level, exhibited minor changes (improvement or deterioration), but most subjects remained within one segment of their initial injury level after 1 year. Recovery of LEMS occurred predominantly in subjects with low thoracic SCI. The sensory zone of partial preservation (ZPP) had no prognostic value for subsequent recovery of sensory levels or LEMS. However, after mid or low thoracic SCI, X3 segments of sensory ZPP correlated with an increased likelihood for AIS grade conversion. Conclusion:The data suggest that a sustained deterioration of three or more thoracic sensory levels or loss of upper extremity motor function are rare events and may be useful for tracking the safety of a therapeutic intervention in early phase acute SCI clinical trials, if a significant proportion of study subjects exhibit such an ascent.

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Section: Discussionmentioning

confidence: 98%

Section: Levelmentioning

confidence: 99%

Characterization of neurological recovery following traumatic sensorimotor complete thoracic spinal cord injury

et al. 2010

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“…Consequently, the nerve roots are the most vulnerable to compression at the entrance of the intervertebral foramina [32]. The presence of numerous nerve root connections [32] may explain the important dermatomal overlap [33].…”

Section: Neurological Symptomsmentioning

confidence: 99%

“…For the diagnosis, examination of sensory and motor disturbances are performed to determine the level of suspected nerve root compression. However, the clinical findings are generally not very precise because of the substantial overlap of cervical nerve roots in the brachial plexus [33].…”

Section: Diagnosis Of Crmentioning

confidence: 99%

Neck disability in patients with cervical radiculopathy and evaluation of structured postoperative physiotherapy

Wibault¹

2015

Linköping University Medical Dissertations

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Non-surgical and surgical approaches to treatment are used in patients with cervical radiculopathy (CR) due to disc disease. Overall, good effects of surgery have been reported on arm pain and neurological symptoms. However, the effects on neck functioning are more uncertain. Studies have shown persistent activity limitations; participation restrictions; and impairments in neck-related body functions after surgery. Structured physiotherapy combining neck-specific exercises with a behavioural approach has been suggested as treatment before as well as after surgery to improve clinical outcomes in patients with CR. Randomized clinical trials of postoperative physiotherapy to inform evidence-based clinical guidelines for the treatment of patients with CR are lacking. The overall aim of the thesis was to investigate the additional benefit of structured postoperative physiotherapy combining neck-specific exercises with a behavioural approach compared to standard postoperative approach in patients with CR. A further aim was to evaluate the contribution of different aspects of neck-related body functions and mental functions on preoperative neck disability in these patients. A total of 202 patients with CR who were scheduled for surgery were recruited, and randomized preoperatively to either structured postoperative physiotherapy, or standard postoperative approach. Standard postoperative approach was in accordance with Swedish postoperative care, and may have included pragmatic physiotherapy after surgery when needed. Patients were evaluated with a set of questionnaires and clinical examinations before surgery and at 3 and 6 months after surgery. Outcomes included patient-reported measures of pain, neck functioning, global outcome, clinical evaluation of neckrelated body functions, self-efficacy and coping strategies, as well as expectation fulfilment and enablement. Differences between treatment groups were investigated in complete case and per-protocol approaches (Paper III & IV). A sub-sample of patients with CR who were scheduled for surgery were also compared with neck-healthy individuals for assessment of head repositioning accuracy with a cervical range of motion device (Paper I). In patients with CR who were scheduled for surgery, associations between preoperative measures of neck-related body functions, mental functions, and other contextual factors with patientreported neck disability were studied (Paper II). With the exception of greater expectation fulfilment in patients who received structured postoperative physiotherapy (p = 0.01), there were no differences between the treatment groups in outcomes at 6 months after surgery. There were no differences reported for changes in outcomes from before surgery to 6 months after surgery between the groups, but all outcomes significantly improved from baseline in both groups (p<0.001) (Paper III & IV). However, global outcome and frequency of neck pain improved during the postoperative period only in patients who received structured postoperative physiot...

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“…Although being a unified organ, the skin of the body is characterized by regional anatomical/histological differences in respect to hair density, epidermal characteristics, thickness of the dermis, and amount of underlying adipose tissue. It is another heterogeneity factor that skin regions can be divided into 30 dermatomes based on the spinal nerve innervation [53]. While these dermatomes are highly uniform in the thoracic and abdominal regions, they are very complex on the extremities.…”

Section: Mechanisms Underlying Regional Distributionmentioning

confidence: 99%

Tumor type-specific and skin region-selective metastasis of human cancers: another example of the “seed and soil” hypothesis

Kovács

Hegedűs

Kenessey

et al. 2013

Cancer Metastasis Rev

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Metastasis of human cancer is an organ-selective process that is determined by anatomical and biological factors as well as by specific microenvironmental properties. Dissemination of visceral malignancies to the skin is rather rare and usually occurs in a later stage of the disease. Using statistical approaches, both positive (renal and lung cancers) and negative (pancreatic and liver cancers) organ preferences can be identified in a variety of cancers. While certain cancer types are characterized by random distribution for skin metastasis (liver cancer), a number of cancers demonstrate a colonization preference to the region of origin: lung cancer to the supradiaphragmatic (mostly chest) and colorectal cancers to the infradiaphragmatic (abdominal) skin regions. In certain cases, however, skin metastasis develops more frequently at specific distant locations, as evidenced by the dissemination of renal cancer at the head and neck region. These findings are clinically relevant and useful especially in patients where skin metastasis is the first indication of a malignancy. Nevertheless, it is a strong argument for the predominant role of microenvironmental factors in cancer dissemination. On the other hand, skin metastases of visceral cancers provide a unique model to analyze the pathomechanisms determining organ selectivity, including the organ-specific vascularization, the dermatome-specific innervation, or immunological and developmental factors.

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An evidence‐based approach to human dermatomes

Cited by 183 publications

References 44 publications

Characterization of neurological recovery following traumatic sensorimotor complete thoracic spinal cord injury

Characterization of neurological recovery following traumatic sensorimotor complete thoracic spinal cord injury

Neck disability in patients with cervical radiculopathy and evaluation of structured postoperative physiotherapy

Tumor type-specific and skin region-selective metastasis of human cancers: another example of the “seed and soil” hypothesis

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