Observed patterns of cervical radiculopathy: how often do they differ from a standard, “Netter diagram” distribution?

McAnany, Steven J.; Rhee, John M.; Baird, Evan O.; Shi, Weilong J.; Konopka, Jeffrey A; Neustein, Thomas M.; Arceo, Rafael

doi:10.1016/j.spinee.2018.08.002

Cited by 18 publications

(17 citation statements)

References 16 publications

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“…Cervical spine Immediately 0. improvements in PPT at the area of supposed affected dermatome. This may partially be attributed to the fact that the observed pattern of pain and numbness differed from the standard dermatomal pattern ("Netter diagram" distribution) in 46% of patients with cervical radiculopathy in a previous study [45].…”

Section: Hpt (°C)mentioning

confidence: 71%

Effect of manual therapy with exercise in patients with chronic cervical radiculopathy: a randomized clinical trial

Alshami

Bamhair

2021

Trials

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Background Research that has examined the effects of cervical spine mobilization on hypoesthesia and hypersensitivity characteristics in patients with cervical radiculopathy is scarce. The aim of this study was to examine the short-term effects of vertebral mobilization on the sensory features in patients with cervical radiculopathy. Methods Twenty-eight participants with chronic cervical radiculopathy were randomly allocated to (1) an experimental group [cervical vertebral mobilization technique and exercise] or (2) a comparison group [minimal superficial circular pressure on the skin and exercise]. Participants received a total of 6 sessions for 3–5 weeks. Numeric Pain Rating Scale (NPRS), Neck Disability Index (NDI), pressure pain threshold (PPT), heat/cold pain threshold (HPT/CPT), and active cervical range of motion (ROM) were measured at baseline immediately after the first session and after the sixth session. Results The experimental group showed improvements from baseline to session 6 in NPRS [mean difference 2.6; 95% confidence interval: −4.6, −0.7], NDI [14; −23.3, −4.3], and active cervical ROM in extension [14°; 2.3, 25.5], rotation [16°; 8.8, 22.5], and lateral flexion to the affected side [10°; 2.3, 16.8]. Improvements were also found in PPT at the neck [124 kPa; 57, 191.1] and C7 level at the hand [99 kPa; 3.6, 194.9]. There were no changes in the HPT and CPT at any tested area (P>0.050). Conclusions Cervical vertebral mobilization for patients with chronic cervical radiculopathy reduced localized mechanical, but not thermal, pain hypersensitivity. Trial registration ClinicalTrials.gov (NCT03328351). Registered on November 1, 2017, retrospectively registered.

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Section: Hpt (°C)mentioning

confidence: 71%

Effect of manual therapy with exercise in patients with chronic cervical radiculopathy: a randomized clinical trial

Alshami

Bamhair

2021

Trials

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“…McAnany et al [ 6 ] reported that, among 239 patients with single-level cervical radiculopathy, only 129 (54%) showed radiating pain and numbness following the standard dermatomal pattern. In present study, 62.6% (142 of 227) of the patients were identified as having the standard dermatomal pattern, which was slightly higher than that in the results reported in previous studies.…”

Section: Discussionmentioning

confidence: 99%

“…Unfortunately, most neurologic manifestations used to determine cervical pathologic level do not have high diagnostic accuracy in the real world [ 5 , 6 ]. Additionally, in clinical practice, patients who have severe nerve root compression on cervical spine MRI frequently do not complain of any symptoms.…”

Section: Introductionmentioning

confidence: 99%

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Reliability and Diagnostic Accuracy of Standard Dermatomes and Myotomes for Determining the Pathologic Level in Surgically Verified Patients With Cervical Radiculopathy

Hong

Nam

2022

Neurospine

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Objective: This study aimed to investigate the reliability and diagnostic accuracy of typical dermatomes and myotomes for determining the pathologic level in surgically verified patients with cervical radiculopathy.Methods: Patients who underwent single-level surgery due to cervical radiculopathy with at least a 60% reduction in preoperative symptoms or recovery of muscle power after surgery were included. The observed clinical symptoms (pain, paresthesia, motor weakness) were compared to those of typical cervical dermatomes and myotomes.Results: Among the 227 patients reviewed, 142 (62.6%) had a standard dermatomal pattern, and 74 of 110 (67.3%) had a standard myotomal pattern. The myotome of C5/6 radiculopathy showed much more variance than those of other cervical segments. Among the patients with severe motor weakness (muscle strength ≤ grade 3 or obvious muscle atrophy), all those with involvement of root C5, C7, and C8 showed a typical pattern (C4/5: 13 of 13 patients, C6/7: 5 of 5 patients, C7/T1: 3 of 3 patients), while only 2 of the 6 patients (33.3%) with severe motor weakness caused by C5/6 radiculopathy fit the typical pattern.Conclusion: Among various symptoms, cervical myotome is of great value in determining the pathological level. However, it should be noted that there is high variability in human dermatomes and myotomes, especially for motor weakness due to C6 root compression, which is more variable than others.

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“…10 Neurological signs, as presented in textbooks, have been tested in patients with a single-level pathology undergoing anterior cervical discectomy and fusion. 11 Only patients with at least 75% improvement were included, and among these, the pattern of pain and numbness followed traditional textbooks in only 54%. Accuracy did not differ by cervical level.…”

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confidence: 99%

Clinical evaluation versus magnetic resonance imaging findings in patients with radicular arm pain—A pragmatic study

Redebrandt

Brandt

Hawran

et al. 2022

Health Science Reports

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Objectives: Cervical nerve root compression can lead to radiculopathy in the arm. Some studies have reported low accuracy in determining the responsible nerve root in both cervical and lumbar regions. This prospective, observational, pragmatic study aimed to determine the accuracy of the clinical evaluation relative to magnetic resonance imaging (MRI) findings in patients with arm radiculopathy.Methods: Patients with neck pain and neck-related arm pain referred to a spine unit underwent a standard clinical neurological examination and cervical spine MRI. The clinical examination required a judgment of the most likely cervical root involved, including the side. The Interobserver reproducibility was tested. Using MRI, the most likely nerve root involved according to radiology was assessed.Results: Eighty-three patients met the inclusion criteria. The Interobserver reproducibility between clinical evaluators was 58%, with a modest κ coefficient (0.33, 95% confidence interval [CI]: 0.18-0.47) classified only as "fair agreement."Only 31% (95% CI: 22-42) of the 83 patients exhibited full agreement regarding the suspected cervical root as assessed via the clinical evaluation and MRI. In another 28% (95% CI: 18-39), the clinical evaluation identified an adjacent level to that identified on MRI.Conclusions: In cervical radiculopathy, the clinical-neurological examination diagnosed the same in 31% or an adjacent cervical root in 28% of the patients in relation to the most affected cervical root on MRI.

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Observed patterns of cervical radiculopathy: how often do they differ from a standard, “Netter diagram” distribution?

Cited by 18 publications

References 16 publications

Effect of manual therapy with exercise in patients with chronic cervical radiculopathy: a randomized clinical trial

Effect of manual therapy with exercise in patients with chronic cervical radiculopathy: a randomized clinical trial

Reliability and Diagnostic Accuracy of Standard Dermatomes and Myotomes for Determining the Pathologic Level in Surgically Verified Patients With Cervical Radiculopathy

Clinical evaluation versus magnetic resonance imaging findings in patients with radicular arm pain—A pragmatic study

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