Cervical Myelography in Traction Injuries of the Brachial Plexus

Yeoman, P

doi:10.1302/0301-620x.50b2.253

Cited by 49 publications

(14 citation statements)

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“…These studies were focused on looking for traumatic meningoceles rather than an abnormality of the roots themselves. [18][19][20][21][22][23] An introduction of water-soluble contrast agents improved the quality of evaluation of the roots and the spinal cord. 24 Such investigation is better tolerated by the patients, can be performed earlier, and can be useful even in the presence of blood within the subarachnoid space.…”

Section: Mechanisms Of Nerve Roots Avulsionmentioning

confidence: 99%

Radiological and Electrophysiological Detection of Nerve Roots Avulsion in Patients with Birth-Related Brachial Plexus Paralysis

Terzis¹,

Novikov²

2005

Seminars in Plastic Surgery

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The differential diagnosis between preganglionic and postganglionic lesions of the brachial plexus at the level of individual roots is critical. Preoperative neuroradiologic and electrophysiological studies are considered useful in detecting of root avulsions of the brachial plexus. In this study, the predictive value of plain cervical myelography, following computed tomography myelography (CTM) and preoperative electrodiagnostic evaluation, in detecting nerve root avulsions in cases of obstetrical brachial plexus paralysis was determined. The charts of 321 patients who had sustained brachial plexus paralysis and were operated on in our center from 1982 to 2003 were reviewed and analyzed. This study includes 70 cases of obstetrical brachial plexus palsy. Preoperative cervical myelography and CTM, as well as electrophysiological studies, were compared with final intraoperative diagnosis. A total of 420 spinal nerves were examined in 70 patients. Fifty-two patients (74.3%) had avulsion injury of brachial plexus. Intraoperatively, 135 roots (32.1%) were found to be avulsed. Accuracy, sensitivity, and specificity of preoperative plain myelography were 85.3%, 71.0%, and 92.3%; of CTM they were 89.4%, 83.2%, and 92.1%, respectively; and of electrodiagnostic studies they were 76.2%, 39.5%, and 93.2%, respectively. CTM and plain myelography were significantly more accurate and sensitive than electrophysiological studies (p < 0.05). There was no statistically significant difference in accuracy and sensitivity between plain myelography and CTM.

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Section: Mechanisms Of Nerve Roots Avulsionmentioning

confidence: 99%

Radiological and Electrophysiological Detection of Nerve Roots Avulsion in Patients with Birth-Related Brachial Plexus Paralysis

Terzis¹,

Novikov²

2005

Seminars in Plastic Surgery

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“…The strength of the FL at these levels and their ability to tether their respective nerve roots is also emphasized upon considering that these levels have the lowest incidence of avulsed nerve roots (in comparison to lower cervical and upper thoracic nerve roots which have the highest incidence of nerve root avulsion and least numerous FL). [41][42][43] Others have argued that cervical FL also become pathological upon calcification, fibrotic degeneration, and hypertrophy, resulting in nerve root entrapment and pain. [44][45][46] Similarly, our results support the view that these ligaments could be pathological in the context of postoperative C5P (resulting from intraforaminal nerve root tethering).…”

Section: Discussionmentioning

confidence: 99%

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

Jack

Osburn

Ramey

et al. 2020

J Brachial Plex Peripher Nerve Inj

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Background Nerve root tethering upon dorsal spinal cord (SC) migration has been proposed as a potential mechanism for postoperative C5 palsy (C5P). To our knowledge, this is the first study to investigate this relationship by anatomically comparing C5–C6 nerve root translation before and after root untethering by cutting the cervical foraminal ligaments (FL). Objective The aim of this study is to determine if C5 root untethering through FL cutting results in increased root translation. Methods Six cadaveric dissections were performed. Nerve roots were exposed via C4–C6 corpectomies and supraclavicular brachial plexus exposure. Pins were inserted into the C5–C6 roots and adjacent foraminal tubercle. Translation was measured as the distance between pins after the SC was dorsally displaced 5 mm before and after FL cutting. Clinical feasibility of FL release was examined by comparing root translation between standard and extended (complete foraminal decompression) foraminotomies. Translation of root levels before and after FL cutting was compared by two-way repeated measures analysis of variance. Statistical significance was set at 0.05. Results Significantly more nerve root translation was observed if the FL was cut versus not-cut, p = 0.001; no difference was seen between levels, p = 0.33. Performing an extended cervical foraminotomy was technically feasible allowing complete FL release and root untethering, whereas a standard foraminotomy did not. Conclusion FL tether upper cervical nerve roots in their foramina; cutting these ligaments untethers the root and increases translation suggesting they could be harmful in the context of C5P. Further investigation is required examining the value of root untethering in the context of C5P.

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“…14,15 One advantage of myelography is its ability to delineate the entire injury. [7][8][9]11 Both techniques, however, involve considerable exposure to radiation and the possibility of reaction to the contrast medium. Myelography is reported to be unreliable at the level of the C5 and C6 nerve roots.…”

Section: Discussionmentioning

confidence: 99%

“…Background vessel signal is suppressed by a T2weighted fast spin-echo pulse sequence with a long echo time, and the fat signal obliterated by a presaturation pulse for fat suppression. Preoperative imaging of brachial plexus injuries has previously been by conventional myelography, [7][8][9][10][11] and postmyelographic CT (CTM). [12][13][14][15] Both, however, involve considerable exposure to radiation, a possible reaction to the contrast material, and the surgical risk of lumbar puncture.…”

mentioning

confidence: 99%

Magnetic Resonance Myelography in Brachial Plexus Injury

Nakamura

Yabe

Homma

et al. 1997

The Journal of Bone and Joint Surgery. British volume

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We used magnetic resonance (MR) myelography in ten patients with injuries to the brachial plexus and compared the findings with those obtained by conventional myelography and postmyelographic CT (CTM). In the presence of complete nerve-root avulsion (seven cases), a post-traumatic meningocele was detected by MR myelography. In injuries to the upper roots (three cases) MR myelography showed abnormal findings with a high signal intensity in the nerve root, obliteration of the damaged nerve root, or enlargement and obliteration of the root sleeve. No pseudomeningoceles were detected in these upper-root injuries by MR myelography and CTM. The overall accuracy of detection of damaged nerve roots or root sleeves was better with MR myelography than with conventional myelography and was similar to that of CTM.MR myelography is non-invasive, relatively quick, requires no contrast medium, provides imaging in multiple projections, and is comparable in diagnostic ability to the more invasive, time-consuming techniques of conventional myelography and CTM.

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Cervical Myelography in Traction Injuries of the Brachial Plexus

Cited by 49 publications

References 0 publications

Radiological and Electrophysiological Detection of Nerve Roots Avulsion in Patients with Birth-Related Brachial Plexus Paralysis

Radiological and Electrophysiological Detection of Nerve Roots Avulsion in Patients with Birth-Related Brachial Plexus Paralysis

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

Magnetic Resonance Myelography in Brachial Plexus Injury

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