Dermatome Hypalgesia with Posterolateral Herniation of Lower Cervical Intervertebral Disc

Abstract

T HE CLINICAL syndrome of nerve root compression by posterolateral herniation of a lower cervical intervertebral disc has been well presented in recent articles by SenmIes and Murphey, 16 Ulmer and Meredith, 2~ Spurling and Scoville, TM Michelsen and Mixter, 13 Bucy and Chenault, 2 Elliott and Kremer, 4 Bradford and Spurling, I Young,21 Eaton} and Murphey and Meade. ~4 It has been brought to attention by these authors that pain which extends from the lower cervical spine over the upper scapula and down the arm, often with associated numb sensation in some part of the hand, commonly is caused by lower cervical disc herniation. Formerly this syndrome has been variously diagnosed as brachial neuritis, radiculitis, fibrositis, myalgia or reflex pain, with focal infection, cervical arthritis, acromial bursitis, cervical rib, scalenus anticus, cardiac or gall bladder disease often suspected in etiology. Now it is necessary to re-evaluate this type of pain and recognize that it more often is due to nerve root compression by herniation of a lower cervical intervertebral disc. Our present state of knowledge of this herniation is at the same stage as that of herniation of a lower lumbar disc ten years ago when the diagnosis of sciatic neuritis was in vogue, with many hypothetical explanations of its cause, now discarded.The cervical spine and the lumbar spine are similar in their mobility, with frequent forward-bending strain placed upon them and occasional fracture or dislocation in these regions from violent force. In the lumbar region heavy weight bearing on a poor mechanical angle with the sacrum is the most important factor in causation of posterolateral herniation of the nucleus pulposus of the 5th, 4th and 3rd lumbar intervertebral discs, in this order of frequency, whereas fracture-dislocation and hypertrophic arthritis occur more frequently in the upper lumbar region. In the cervical spine similar stress and strain frequently lead to narrowing and border hyperostosis of the lower cervical intervertebral discs, commonly seen in roentgenograms, and at this same site fracture-dislocation usually occurs, indicating that this is the site of greatest combined strain in the neck.Recognition that pathology of the lower cervical discs produces nerve root symptoms has antedated recognition of discrete posterolateral cervical disc herniation, just as other pathology in the lumbar spine was previously used to explain nerve root compression symptoms of disc herniation there. Oppenheimer and Turner ~5 have written extensively of what they have 115

C2 and C3 Pain Dermatomes in Man

“…These dermatomes are referred to, respectively, as embryonic, herpetic, vasodilatation and tactile dermatomes. Pain dermatomes, defined by areas of hypalgesia associated with nerve root lesions, have also been described but not for C2 and C3 (6). This study defines the C2 and C3 pain dermatomes in a personal series of 17 patients.…”

Headache relief after anterior cervical discectomy: post hoc analysis of a randomized investigational device exemption trial

“…A classic case series from 1946 described a 17-year-old girl with C-5 pathology and headaches, without other symptoms. 11 In 1948 Raney and Raney published a series of 4 patients with headache and lower cervical disc pathology, and these authors subsequently proposed the theory that headache following traumatic brain injury might be referable to cervical structures. 21 This theory was furthered by Braaf and Rosner in 1975.…”

Schmerztopik bei lumbalen Bandscheibenschäden

“…Durch experimentell physiologische Arbeiten (z. B. das Beschreiben hypalgetischer Areale bei Kompressionssyndromen, Applikation von Lokalanästhetika beim Gesunden) wurden genauere Modelle erstellt (Sherrington 1898, Förster 1936, Keegan 1947 [7 -9]. Bemerkenswert ist, dass sowohl schon Bolk und Sherrington als auch später Förster auf das Überlappen der einzelnen Hautsegmente aufmerksam machten, wobei die Zonen der Schmerzempfindung schmäler sind und sich weniger über-lagern als die Zonen der Berührungsempfindung.…”

“…Erst 2001 stellt Wolff et al ein modifiziertes Modell ("adapted map") vor, welches auf diese wesentliche anatomische Variabilität Rücksicht nimmt [39]. Das Modell von Keegan (1947) ist insofern hervorzuheben, da es sich als "Lehrmodell" vor allem im anglo-amerikanischen Sprachraum etablierte [9]. Auf Grundlage der oben angeführten Arbeiten und fortführender klinischer Beobachtungen (z.…”