The Dermatomes in Man

Foerster, O.

doi:10.1093/brain/56.1.1

Cited by 329 publications

(99 citation statements)

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“…frequent intervals. The level of anesthesia was conservatively determined by sensory stimulation, the dermatomes being designated according to the recent description of Foerster (28). Complete loss of all sensation up to and including the umbilicus was taken to indicate anesthesia of the posterior roots up to and including T12; to the xiphoid process, T7; to just below the nipple, T6; to just above the nipple, T5; to the clavicle, T2; to the inner aspect of the forearm, Ti; to the hollow above the clavicle and the outer shoulder, C4; to the neck, C3.…”

Section: Methodsmentioning

confidence: 99%

The Effects of Spinal Anesthesia on the Circulation in Normal, Unoperated Man With Reference to the Autonomy of the Arterioles, and Especially Those of the Renal Circulation

Smith

Rovenstine²,

Goldring³

et al. 1939

J. Clin. Invest.

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The present study, comprising observations on 21 subjects given high spinal anesthesia, is an investigation of the effects of anesthetic denervation in normal man, uncomplicated by surgical intervention, on the circulation with particular reference to the vascular bed of the kidney. It is concluded that the renal arterioles are distinctly autonomous, in the sense that under basal conditions the renal vascular tone is not affected by anesthetic denervation. Our observations further suggest that the arteriolar bed generally (apart from the skin) possesses considerably more autonomy than is usually attributed to it-sufficient, in fact, in the normal supine individual at rest, to maintain an essentially normal arterial pressure. We find no evidence of significant arteriolar dilatation during high spinal anesthesia, such reduction in blood pressure as occurs being attributable, we believe, to diminished circulating blood volume in consequence of dilatation of the capillaries, venules, and veins.Part I deals with the following topics: (1) Methods; (2) the effects of spinal anesthesia on renal blood flow; (3) on the arterial pressure, and (4) on the reflex responses to posture, hypercapnia, and anoxemia. Part II consists of a review of the evidence on (5) the existence of tonic vasoconstrictor activity and on (6) the existence of autonomy in the peripheral arterioles generally, and (7) in the kidney in particular, and (8) the peripheral effects of hypercapnia and anoxemia. In (5) it is brought out that the notion of tonic vasoconstrictor activity in the sympathetic nervQus system, apart from the skin, is based largely upon animal experiments which are seriously complicated by general anesthesia, venous dilatation, etc., and that the information so obtained cannot be transferred with confidence to normal animals, and certainly not to man.PART I MethodsThe subjects were male convalescent patients ranging in age from 18 to 50 years who, with a single exception, presented no abnormal signs contraindicating selection for this study. They were examined in the morning in the basal, fasting condition, and were prepared for the measurement of renal blood flow and filtration rate by the clearance method, as described by Smith, Goldring, and Chasis (93). In the earlier observations the phenol red and inulin (35) clearances were followed, but after the introduction of the diodrast clearance (93), all three clearances were used. The phenol red clearance serves as a check on the diodrast clearance, the constancy of the phenol red/diodrast clearance ratio before and after anesthesia demonstrating that procaine per se has no effect upon the tubular excretory mechanism. The infusions corresponded to the typical infusion cited by Chasis, Ranges, Goldring, and Smith (18). Zero time was taken as the beginning of the priming infusion, which occupied about 10 minutes; the infusion was then changed to the sustaining infusion, the first urine collection period being started at about 30 minutes. The sustaining infusion was usually interrupted ...

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Section: Methodsmentioning

confidence: 99%

The Effects of Spinal Anesthesia on the Circulation in Normal, Unoperated Man With Reference to the Autonomy of the Arterioles, and Especially Those of the Renal Circulation

Smith

Rovenstine²,

Goldring³

et al. 1939

J. Clin. Invest.

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“…The results of these studies indicate that this technique has significant limitations in detecting monosegmental dorsal root dysfunction. Because neither the large nerve stems nor the cutaneous branches of the myelinated Ab-fiber spectra represent a single dorsal root, afferent neuronal activation reaches the spinal cord and brain along several adjacent dorsal roots, thereby bypassing the lesion [4,8,9,11,24]. Therefore, electrophysiological testing using SEP on the Ab-fiber system is ineffective for clinical questions concerning dorsal root function.…”

Section: Discussionmentioning

confidence: 99%

Laser-evoked potentials: prognostic relevance of pain pathway defects in patients with acute radiculopathy

2009

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The radicular pain syndrome is a major problem in public health care that can lead to chronic back and leg pain in 30%. Ischalgia and back pain are the most prominent signs of dorsal root affection. Until now, no clinical or neurophysiological test procedure exists that evaluates the function of the dorsal root and predicts the prognosis of patients suffering from RPS. We have recently demonstrated that laser-evoked potentials (LEP) are able to demonstrate dorsal root damage. With this study, we investigated 54 patients with acute radicular symptoms and compared LEP parameters (side to side difference of latency and amplitude, transformed to a z-score) with their state of health after 3 months to calculate their predictive value for outcome prognosis. Most significantly, the latency difference between the LEP of the affected dermatome relative to the contralateral healthy dermatome was able to predict the prognosis. Latency z score above two demonstrates a 91% specificity (33% sensitivity) for a poor outcome at 3 months. A significant relation between amplitude changes and the main outcome measure could not be shown. Only extreme changes (z score [10) in amplitude show a high specificity for the persistence of ischialgia in particular (specificity 0.94; sensitivity 0.35). All other parameters, such as clinical scores or other LEP parameters, were not able to predict the outcome of patients. We propose that clinical testing using LEP with latency analysis is a useful tool for estimating the course of disease, so that patients with poor predictive parameters can be treated more invasively at early disease stages to avoid persistence of radiculopathy.

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“…Although there was potential for the larger thermode (see Subjects and methods) to straddle an adjacent dermatome placement on the key ASIA points ensured that it did not. This being the case, it is relevant that thermal dermatomes are invariably smaller than tactile dermatomes and have minimal overlap, 20 making it unlikely that a thermode testing the lowest normal dermatome would also have contacted skin innervated by the next (lower) abnormal level.…”

Section: Discussionmentioning

confidence: 99%

Thermal perception thresholds: assessing the level of human spinal cord injury

Nicotra

Ellaway

2006

Spinal Cord

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Study design: Controlled, cross-sectional, observational. Objectives: To investigate whether quantitative sensory testing (QST) is able to reveal subclinical deficits at the neurological level of lesion in subjects with chronic spinal cord injury (SCI). Setting: National Spinal Injuries Centre, Stoke Mandeville Hospital and Imperial College London, UK. Methods: QST and clinical assessments were carried out on 18 subjects with complete SCI (American Spinal Injury Association (ASIA) grade A) and 10 subjects with incomplete SCI (ASIA grades B, C or D). A total of 10 healthy subjects acted as controls. Results: At the level of lesion perceptual thresholds to monofilaments, cold pain and heat pain were similar to values in control subjects but cool and warm thresholds were significantly raised. A correlation between cool and warm thresholds was observed at the level of lesion in complete SCI and between heat and cold pain thresholds at the level of lesion in complete SCI, incomplete SCI and in control subjects. In the zone of partial preservation in complete SCI and below the level of lesion in incomplete SCI, thresholds for all modalities were all different compared to controls. Conclusion: QST reveals impaired thermal sensation in dermatomes clinically defined as normal with ASIA standards. Quantitative thermal testing therefore permits a discriminating assessment of preserved sensation and subclinical deficit and has the potential to improve upon the clinical detection of natural recovery or changes in level of injury following interventions designed to repair SCI.

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The Dermatomes in Man

Cited by 329 publications

References 0 publications

The Effects of Spinal Anesthesia on the Circulation in Normal, Unoperated Man With Reference to the Autonomy of the Arterioles, and Especially Those of the Renal Circulation

The Effects of Spinal Anesthesia on the Circulation in Normal, Unoperated Man With Reference to the Autonomy of the Arterioles, and Especially Those of the Renal Circulation

Laser-evoked potentials: prognostic relevance of pain pathway defects in patients with acute radiculopathy

Thermal perception thresholds: assessing the level of human spinal cord injury

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