C7 Nerve Research Articles

Cervical Myeloradiculopathy With Bilateral Foraminal Stenosis Treated by Unilateral Biportal Endoscopic Decompression with Alternating Hemilaminectomy and Bilateral foraminotomy: A Case Report and Technical Note

Cervical myeloradiculopathy is a debilitating condition characterized by progressive spinal cord dysfunction commonly caused by degenerative changes in the cervical spine. It typically exhibits an insidious onset and progressive functional decline, along with multiple exiting nerve root entrapments bilaterally in some patients. Traditional surgical interventions, such as discectomy and fusion, are associated with some complications and limitations. Unilateral biportal endoscopic (UBE) decompression can have significant advantages over traditional techniques when cervical central and bilateral foraminal decompression is required. In this case report and technical note, we describe our experience with this novel surgical technique for the treatment of cervical myelopathy. A 67-year-old patient presented with progressive neck pain; bilateral upper extremity radiculopathy; loss of power and sensation in the C5, C6, and C7 nerve root distribution; gait imbalance, and spasticity. Magnetic resonance imaging revealed multilevel cervical spondylosis with central canal and bilateral foraminal stenosis. The patient underwent UBE central and bilateral foraminal decompression. At a 9-month follow-up visit, he was able to walk unassisted, his reflexes had returned to normal, no spasticity was observed, and he had good grip strength in both hands. This is a novel technique of UBE decompression with bilateral foraminotomy at the C4–5, C5–6, and C6–7 levels and laminectomy named “the floating tip technique.” The procedure involved bilateral 3-level lamino-foraminotomy and hemilaminotomy on both C5 and C6. A hemilamina was removed on the opposite sides, and flavectomy was performed. Postoperative computed tomography findings showed an intact, complete muscular mass with an intact central spinous process. Therefore, this method was labelled the “floating tip technique.”

Anatomical study of single incision contralateral C7 nerve transfer through subdural pathway.

To explore the feasibility of single incision C7 nerve transfer surgery through the subarachnoid pathway on the healthy side through anatomical research. Four fresh frozen cadaver specimens were used for the study. Observe and measure the length of C7 nerve root fibers. Divide the front root into 3 bundles and the rear root into 5 bundles. The C7 nerve has a filamentous structure, arranged symmetrically on both sides, and the length of the root fibers gradually shortens from top to bottom. The length of the left anterior root decreased from (12.25 ± 0.68) mm to (9.75 ± 1.40) mm, the length of the right anterior root decreased from (12.95 ± 1.49) mm to (10.00 ± 2.00) mm, the length of the left posterior root decreased from (15.63 ± 1.55) mm to (12.38 ± 0.71) mm, and the length of the right posterior root decreased from (15.48 ± 1.37) mm to (12.30 ± 0.90) mm. The distance from the exit of the C7 nerve from the dura mater to the fusion site in 4 specimens was (10.98 ± 1.21) mm on the left and (10.98 ± 1.391) mm on the right. All four specimens have completed nerve bundle anastomosis. From an anatomical perspective, it is feasible to anastomose the healthy side C7 nerve with the affected side root fibers in the dorsal bundle of the spinal cord after cutting off the dura mater.

Extent of Pain Distribution in Entrapment of the Greater Occipital Nerve Identified Through Skin Lesions of Herpes Zoster Involving the Greater Occipital Nerve

Herpes zoster (HZ) involving the upper cervical nerves (C2-C4), which innervate the posterior head, is rare. There have also been few reports of HZ lesions involving the greater occipital nerve (GON), which refers to the medial branch of the dorsal ramus of the second cervical nerve. Pain due to GON entrapment radiates not only to the temporo-occipital region, but also to the ear, retro-auricular and sub-auricular areas of the neck, the angle of the jaw, and the posterolateral neck. Herein, we present the case of a patient who underwent decompression surgery for referred trigeminal pain due to GON entrapment and who developed HZ one week later. Skin lesions of HZ involving the GON occurred not only in the occipital area but also in the ipsilateral ear, auricle, posterior and anterolateral neck. This case of HZ involved all cutaneous areas innervated by the C2, C3, and C4 spinal nerves. The extent of the skin lesions indicated where the pain from the GON radiated.

A Novel Ultrasound-Guided Cervical Plexus Block: A Cadaveric Canine Study.

The ultrasound-guided cervical plexus plane (US-CPP) block has proven effective in humans; yet its application in dogs remains unexplored. This study aimed to describe a novel US-CPP approach in canines. A local sonoanatomy was mapped, the injection technique was tested, and a gross anatomical dissection (GAD) was performed on one cadaver. The bilateral injectate spread and nerve staining were then evaluated via a CT scan and GAD in the six cadavers. The transducer was aligned parallel to the cervical spine, caudal to the atlas. After identifying the cleidocervical and omotransversarius muscles and the C2-C3 interfascial plane, a spinal needle was inserted in-plane, and 0.15 mL/kg of a dye-contrast solution was injected. CT imaging showed the contrast reaching the C1, C2, and C3 vertebral bodies in 3 out of 12 (3/12), 11/12, and 12/12 injections, respectively, and the C4, C5, and C6 vertebrae in 8/12, 5/12, and 1/12 injections, respectively. No contrast was detected in the epidural space. The C1, C2, C3, C4, and C5 nerves were stained in 3/12, 10/12, 8/12, 2/12, and 0/12 injections, respectively. No significant differences were observed between the groups (p > 0.05). A single US-CPP injection successfully stained the C2 and C3 nerves, indicating the potential clinical applicability, although the injected volume rarely reached C4 and C5.

C1 root decompression as a therapeutic target in non-suboccipital non-Valsalva related headache associated with Chiari I malformation

Headache is the most common symptom impacting the quality of life of patients with Chiari I malformation. While headaches typically present in the occipital or suboccipital regions, and induced by Valsalva maneuver, complex migraine-like headaches referring to frontal or orbital regions also occur. Our study explores the therapeutic potential of C1 nerve root decompression in addition to increasing intracranial compliance in patients with Chiari I malformation. We retrospectively analyzed cases operated on for Chiari I malformation, focusing on patients with non-suboccipital, non-Valsalva induced headaches. Preoperative and postoperative visual analog scale (VAS) scores and headache frequency were recorded. Surgical technique involved suboccipital craniectomy, C1 laminectomy, cerebellar tonsil reduction, and C1 root decompression. Twelve patients (10 females, 2 males) aged 22-52 were included. Preoperative mean VAS score was 8, which improved to 2 or less in 11 patients postoperatively. The mean headache frequency decreased significantly. Our findings suggest that C1 root compression contributes to atypical headaches in Chiari I malformation and that C1 root decompression may improve surgical outcomes.

Anatomic Study and Clinical Application of C7 Nerve Transfer Surgery via the Anterior Vertebral Approach for Central Upper Limb Spastic Paralysis

Objective: To explore the anatomic characteristics of C7 nerve localization, course, and length during cross-transfer surgery of the C7 nerve through the anterior vertebral approach and investigate the feasibility, safety, and clinical efficacy of C7 nerve transfer surgery through the anterior vertebral approach for the treatment of central upper limb spastic paralysis. Methods: Four fresh-frozen adult head and neck samples were selected. C7 nerve transfer surgery was simulated through the anterior vertebral approach. The vertical distance between the C7 nerve and the medial edge of the clavicle, the length of the C7 nerve, and the shortest distance of C7 nerve transfer required through the anterior vertebral approach were measured. This was a retrospective analysis of the clinical data of 2 patients with central upper limb spastic paralysis after C7 nerve transfer surgery at Northern Jiangsu People’s Hospital affiliated with Yangzhou University. The patients were all female, aged 50 to 51 years, with upper limb paralysis on the affected side. The muscle strength was grade 0 or grade 1, and the muscle tension was relatively high. Both patients underwent C7 nerve transfer surgery through the anterior vertebral approach. Upper limb sensation and motor function were observed. Results: Bilateral C7 nerves can be fully exposed and located through the anterior vertebral approach. The C7 nerve runs between the anterior and middle scalene muscles, with a vertical distance of 1.7 to 2.5 (2.1±0.3) cm from the inner edge of the clavicle. The length of the C7 nerve is 5.6 to 6.8 (6.4±0.5) cm, and the shortest distance of C7 nerve transfer through the anterior vertebral approach is 4.8 to 5.7 (5.3±0.4 cm). Two patients with central upper limb paralysis successfully underwent C7 nerve transfer surgery using the anterior vertebral approach. Two patients had normal motor function in the healthy upper limb after surgery but experienced pain and numbness in the healthy upper limb. Both patients recovered within 1 month. Two patients experienced significant relief of spasticity symptoms in the affected upper limb. One patient was followed up for 15 months, and, at the last follow-up, sensation in the affected upper limb was normal, with proximal muscle strength at level 3 and distal muscle strength at level 2. Another patient was followed up for 11 months, and at the last follow-up, sensation in the affected upper limb was normal, with proximal muscle strength at level 1+ and distal muscle strength at level 1. Conclusion: For central upper limb spastic paralysis, C7 nerve transfer surgery through the anterior vertebral approach is safe and feasible and is a good treatment option. Related anatomic research can effectively guide clinical surgery and assist in locating the C7 nerve, and incising the musculus longus colli can shorten the distance of C7 nerve transfer.

Satisfaction of patients with frozen shoulder following silent manipulation: a prospective observation study.

Silent manipulation is a procedure for frozen shoulders that involves manipulating the shoulder while the patient is awake by performing C5, C6, and C7 cervical nerve root block under ultrasound guidance. This retrospective study, conducted at Yokohama City University Hospital, aimed to evaluate the clinical outcomes of silent manipulation and assess whether the experience level of the practitioner influenced treatment efficacy. Between October 2020 and January 2022, 53 patients who met the inclusion criteria underwent silent manipulation for frozen shoulder. The procedure was performed by either an experienced or a less experienced practitioner, and the patients were followed-up for up to 1year post-treatment. Silent manipulation resulted in significant improvements in shoulder range of motion, as measured by forward flexion, abduction, external rotation, and hand-behind-back, as well as in patient-reported outcomes, including disabilities of the arm, shoulder, and hand and Shoulder 36 scores. These improvements were observed 1week, 3months, and 1year after silent manipulation, indicating the short-term efficacy of the procedure. Furthermore, this study revealed that the practitioners' level of experience played a significant role in the outcomes. The experienced doctor achieved better 1st external rotation and belt tying outcomes, as well as Shoulder 36 pain, muscle strength, and activities of daily living domain scores. This suggests that technical expertise in silent manipulation is crucial to achieve optimal outcomes. Silent manipulation offers an effective therapeutic approach for frozen shoulder, leading to significant improvements in range of motion and patient satisfaction. Practitioner expertise is a vital factor in treatment success, emphasizing the importance of skilled professionals in the performance of this procedure.

Individualized C1-2 intra-articular three-dimensional printed porous titanium alloy cage for craniovertebral deformity

BackgroundCongenital craniovertebral deformity, including basilar invagination (BI) and atlantoaxial instability (AAI), are often associated with three-dimensional (3D) deformity, such as C1-2 rotational deformity, craniocervical kyphosis, C1 lateral inclination, among other abnormalities. Effective management of these conditions requires the restoration of the 3D alignment to achieve optimal reduction. Recently, 3D printing technology has emerged as a valuable tool in spine surgery, offering the significant advantage of allowing surgeons to customize the prosthesis design. This innovation provides an ideal solution for precise 3D reduction in the treatment of craniovertebral deformities.ObjectiveThis study aims to describe our approach to individualized computer-simulated reduction and the design of C1-2 intra-articular 3D printed porous titanium alloy cages for the quantitative correction of craniovertebral junction deformities.MethodsA retrospective analysis was conducted on patients with craniovertebral deformities treated at our institution using individualized 3D-printed porous titanium alloy cages. Preoperative CT data were used to construct models for 3D realignment simulations. Cage designs were tailored to the simulated joint morphology following computer-assisted realignment. Preoperative and postoperative parameters were statistically analyzed.ResultsFourteen patients were included in the study, with a total of 28 3D-printed porous titanium alloy cages implanted. There were no cases of C2 nerve root resection or vertebral artery injury. All patients experienced symptom relief and stable implant fixation achieved in all cases. No implant-related complications were reported.ConclusionThe use of individualized computer-simulated reduction and the design of C1-2 intra-articular 3D printed porous titanium alloy cage facilitates precise 3D realignment in patients with craniovertebral deformities, demonstrating effectiveness in symptom relief and stability.

Contrast-enhanced magnetic resonance neurography for diagnosing brachial plexopathy: improved visualization and additional imaging features

Contrast-enhanced magnetic resonance neurography (CE-MRN) holds promise for diagnosing brachial plexopathy by enhancing nerve visualization and revealing additional imaging features in various lesions. This study aims to validate CE-MRN’s efficacy in improving brachial plexus (BP) imaging across different patient cohorts. Seventy-one subjects, including 19 volunteers and 52 patients with BP compression/entrapment, injury, and neoplasms, underwent both CE-MRN and plain MRN. Two radiologists assessed nerve visibility, with inter-reader agreement evaluated. Quantitative parameters such as signal intensity (SI), contrast-to-noise ratio (CNR), and contrast ratio (CR) of the C7 nerve were measured. Both qualitative scoring and quantitative metrics were compared between CE-MRN and plain MRN within each patient group. Patient classification followed the Neuropathy Score Reporting and Data System (NS-RADS), summarizing additional imaging features for each brachial plexopathy type. Inter-reader agreement for qualitative assessment was strong. CE-MRN significantly enhanced BP visualization and nerve-tissue contrast across all cohorts, particularly in volunteers and patients with injuries. It also uncovered additional imaging features such as hypointense signals in ganglia, compressed nerve sites, and neoplastic enhancements. CE-MRN effectively mitigated muscle edema and vascular contamination, enabling precise classification of BP injuries. Overall, CE-MRN consistently enhances BP visualization and provides valuable imaging features for accurate diagnosis.

Shoulder Traction as a Possible Risk Factor for C5 Palsy in Anterior Cervical Surgery: A Cadaveric Study.

Background and Objectives: Many risk factors for postoperative C5 palsy (PC5P) have been reported regarding a "cord shift" after a posterior approach. However, there are few reports about shoulder traction as a possible risk factor of anterior cervical surgery. Therefore, we assessed the stretched nerve roots when shoulder traction was applied on cadavers. Materials and Methods: Eight cadavers were employed in this study, available based on age and the presence of foramen stenosis. After dissecting the sternocleidomastoid muscle of the cadaver, the shoulder joint was pulled with a force of 2, 5, 8, 10, 15, and 20 kg. Then, the stretched length of the fifth nerve root was measured in the extra-foraminal zone. In addition, the same measurement was performed after cutting the carotid artery to accurately identify the nerve root's origin. After an additional dissection was performed so that the superior trunk of the brachial plexus could be seen, the stretched length of the fifth and sixth nerve roots was measured again. Results: Throughout the entire experiment, the fifth nerve root stretched out for an average of 1.94 mm at 8 kg and an average of 5.03 mm at a maximum force of 20 kg. In three experiments, the elongated lengths of the C5 nerve root at 8 kg and 20 kg were 1.69/4.38 mm, 2.13/5.00 mm, and 0.75/5.31 mm, respectively, and in the third experiment, the elongated length of the C6 nerve root was 1.88/5.44 mm. Conclusions: Although this was a cadaveric experiment, it suggests that shoulder traction could be the risk factors for PC5P after anterior cervical surgery. In addition, for patients with foraminal stenosis and central stenosis, the risk would be higher. Therefore, the surgeon should be aware of this, and the patient would need sufficient explanation.

Posterior Release, Reduction, and Intra-Articular Fusion for Irreducible Type III Atlantoaxial Rotary Fixation.

For irreducible atlantoaxial rotary fixation (AARF), anterior or posterior release was often needed before posterior reduction and fusion. Anterior atlantoaxial joint release has potential complications such as retropharyngeal abscess, persistent hoarseness, and infection. This study aims to assess the efficacy of posterior release, reduction, and intra-articular fusion without resecting the C2 nerve root on irreducible type III AARF. The data of 9 pediatric patients diagnosed with AARF who underwent posterior atlantoaxial release, reduction, and intra-articular fusion without resecting the C2 nerve root were retrospectively reviewed. Japanese Orthopaedic Association scores and Visual Analog Scale for Neck Pain were used to assess outcomes. The preoperative and follow-up assessments of atlantodens interval (ADI) were documented to evaluate the reduction of atlantoaxial joint. The patient demographics, surgery time, blood loss, bone fusion time, follow-up period, and surgery-related complications were meticulously documented. The mean follow-up duration was 35.1 ± 11.5 months. Complete reduction was achieved in 8 patients, while one patient did not achieve complete reduction. The ADI decreased significantly from 8.7 ± 2.2 mm before surgery to 2.1 ± 1.3 mm at the final follow-up. All patients demonstrated successful bone fusion, with an average fusion period of 3.7 ± 1.3 months. The Visual Analog Scale for Neck Pain at the final follow-up exhibited a significant decrease compared with preoperative values (P < .05), while no significant difference was observed in Japanese Orthopaedic Association scores. There were no complications related to surgery. Posterior atlantoaxial release, reduction, and intra-articular fusion with a C2 nerve root preservation technique is effective in the treatment of irreducible type III AARF.

Meridian massage in the treatment of cervical spondylotic radiculopathy

To observe the clinical efficacy of meridian massage in the treatment of cervical spondylotic radiculopathy. Sixty-four patients with cervical radiculopathy treated from March 2020 to June 2023 were divided into the observation group and the treatment group, with 32 cases in each group. The observation group received conventional treatment, including 14 males and 18 females with an average age of (41.34±7.23) years old ranging from 32 to 55 years old;the disease duration ranged from 9 to 17 months with an average of (14.23±3.56) months;C5 and C6 nerve root compression occurred in 12 cases, C7 nerve root compression occurred in 17 cases, C8 nerve root compression occurred in 3 cases. The treatment group received massage therapy on the basis of conventional treatment, including 17 males and 15 females with an average age of (40.86±6.97) years old ranging from 30 to 54 years old;the disease duration ranged from 8 to 18 months with an average of (15.43±3.48) months;C5 and C6 nerve root compression occurred in 14 cases, C7 nerve root compression occurred in 16 cases, C8 nerve root compression occurred in 2 cases. The clinical efficacy was evaluated by visual analogue scale(VAS), neck disability index(NDI) and clinical assessment scale for cervical spondylosis(CASCS) before and after 2-week treatment, and the range of motion of cervical spine was compared before and after treatment. After 2-week treatment, the VAS and NDI scores of the treatment group and the observation group decreased, while the CASCS scores increased(P<0.001). After 2-week treatment, the VAS and NDI scores were lower and the CASCS scores were higher in the treatment group than those of the observation group(P<0.001). Comparing with those before treatment, the range of motion of flexion, extension, left flexion, right flexion, left rotation and right rotation after 2-week treatment increased in two groups(P<0.05). Comparing with the observation group, the range of motion of flexion, extension, left flexion, right flexion, left rotation and right rotation increased more significantly in the treatment group(P<0.05). Meridian massage is effective in the treatment of cervical Spondylotic radiculopathy, which can effectively relieve neck pain, improve clinical symptoms and improve patient satisfaction.

Risks for prolonged mechanical ventilation and reintubation after cervical malignant tumor surgery: a nested case-control study.

Prolonged mechanical ventilation (PMV) and reintubation are among the most serious postoperative adverse events associated with malignant cervical tumors. In this study, we aimed to clarify the incidence, characteristics, and risk factors for PMV and reintubation in target patients. This retrospective nested case-control study was performed between January 2014 and January 2020 at a large spinal tumor center in China. Univariate analysis was used to identify the possible risk factors associated with PMV and reintubation. Logistic regression analysis was performed to estimate the odds ratios (ORs) and 95% confidence intervals (CIs) with covariates of a probability < 0.05 in univariate analysis. From a cohort of 560 patients with primary malignant (n = 352) and metastatic (n = 208) cervical tumors, 27 patients required PMV and 20 patients underwent reintubation. The incidence rates of PMV and reintubation were 4.82% and 3.57%, respectively. Three variables (all p < 0.05) were independently associated with an increased risk of PMV: Karnofsky Performance Status < 50 compared to ≥ 80, operation duration ≥ 8h compared to < 6h, and C4 nerve root encased by the tumor. Longer operative duration and preoperative hypercapnia (all p < 0.05) were independent risk factors for postoperative reintubation, both of which led to longer length of stay (32.6 ± 30.8 vs. 10.7 ± 5.95days, p < 0.001), with an in-hospital mortality of 17.0%. Our results demonstrate the risk factors for PMV or reintubation after surgery for malignant cervical tumors. Adequate assessment, early detection, and prevention are necessary for this high-risk population.

Cervicomedullary cavernous malformation of the C1 nerve root: illustrative case.

Cavernous malformations (CMs) originating from spinal nerve roots are rare but can present with rapidly progressing neurological deficits. Therefore, quick identification and treatment are essential. The authors present the case of a 52-year-old male presenting with headaches and gait disturbance, found to have a CM of the C1 nerve root. The patient underwent successful suboccipital craniectomy and C1 laminectomy, with complete resection of the lesion, preservation of the cervical spinal nerve roots, and symptomatic improvement postoperatively. This is the first presentation in the literature of a CM originating from the C1 nerve root. The authors show complete resection of the lesion with preservation of the C1 nerve root. Nerve root lesions usually show insidious symptomatic onset. Quick identification and resection are recommended to prevent permanent neurological disability. https://thejns.org/doi/10.3171/CASE2456.

Successful Rectification of Cervical Nerve Root Irritation with Sequential Surgical Maneuvers during Posterior Cervical Instrumentation

AbstractPosterior cervical instrumentation is used to treat a variety of cervical pathologies, including cervical spondylotic myelopathy, severe canal stenosis, and degenerative diseases. A 55-year-old man with severe cervical canal stenosis underwent a C3–C6 laminectomy and lateral mass screw fixation under general anesthesia. After lateral mass screw fixation and rod placement on the right side, raw electromyography (EMG) revealed irritative discharges in the right biceps brachii muscle. Following a suspicion of irritation/mechanical stretching of the C5–C6 nerve root, a posterior foraminotomy was performed on the right side as a rescue measure. The amplitude of raw EMG irritative discharges in the right biceps brachii muscle decreased significantly after posterior foraminotomy. Following rod reapplication with decreased rod lordosis, the irritative EMG discharges were eliminated. Before implementing further measures, posterior foraminotomy can be a crucial initial intervention for minimizing nerve root irritation due to mechanical factors after cervical lateral mass screw fixation.

Modified Atlantoaxial Arthrodesis Technique for Atlantoaxial Instability via Intraarticular Autografting Using Structural Iliac Bone: Technical Nuances and Case Series

ObjectiveThe present study described a modified technique of atlantoaxial arthrodesis in patients with atlantoaxial instability (AAI) along with the postoperative clinical and radiological results. MethodsFive patients underwent this method for their AAI concurrent with C1 arch hypoplasia and/or the development of odontoid pannus causing myelopathy. After thorough exposure of the posterior surface of the C1-2 complex, the bilateral C2 nerve roots were sectioned to allow for easier access to the C1/2 facet joints. To prepare a suitable grafting bed, the C1/2 facet capsule was opened, then the articular cartilaginous and synovial tissues were thoroughly removed. After being properly fashioned to match the gap between the C1/2 facet joint spaces, the structural bone grafts from the iliac crest were directly inserted into the facet joint spaces. To alleviate cord compression caused by concomitant odontoid pannus and/or hypoplastic C1 arch, C1 laminectomy was necessitated in all cases. Subsequently, posterior screw-rod instrumental fixation was conducted. ResultsAll five patients underwent this procedure successfully. Clinical and radiological follow-up data of all patients indicated favorable relief of clinical symptoms and early rigid C1-2 stability. The sequelae of C2 nerve resection were not remarkable. No other neural or vascular damage associated with this technique was observed. ConclusionModified atlantoaxial arthrodesis via intraarticular autografting using the structural iliac bone combined with posterior instrumentation appears to be an efficient alternative treatment method for AAI patients with concurrent pathologies, even when the C1-2 posterior arches are unavailable for the grafting bed.

The prerequisites and clinical outcomes of ipsilateral C7 nerve root transfer to the upper trunk for adult C5-C6 brachial plexus injuries.

Although ipsilateral C7 nerve transfer is used for the treatment of C5-C6 brachial plexus injuries, accurately evaluating the functional quality of the donor nerve (ipsilateral C7 nerve root) is difficult, especially when the C7 nerve root is slightly injured. The purpose of this study was to determine the indicators to evaluate the quality of the ipsilateral C7 nerve and assess the clinical outcomes of this procedure. This study employed the following three indicators to assess the quality of the ipsilateral C7 nerve: (1) the muscle strength and electrophysiological status of the latissimus dorsi, triceps brachii, and extensor digitorum communis; (2) the sensibility of the radial three digits, especially the index finger; and (3) the intraoperative appearance, feel and electrophysiological status of the ipsilateral C7 nerve root. Transfer of the ipsilateral C7 nerve root to the upper trunk was implemented only when the following three tests were conducted, the criteria were met, and the clinical outcomes were assessed in eight patients with C5-C6 brachial plexus injuries. Patients were followed-up for an average of 90 ± 42months. At the final follow-up, all eight patients achieved recovery of elbow flexion, with five and three patients scoring M4 and M3, respectively, according to the Medical Research Council scoring. The shoulder abduction range of motor recovery averaged 86 ± 47° (range, 30°-170°), whereas the shoulder external rotation averaged 51 ± 26° (range, 15°-90°). Ipsilateral C7 nerve transfer is a reliable and effective option for the functional reconstruction of the shoulder and elbow after C5-C6 brachial plexus injuries when the three prerequisites are met.

Posterior Transdural Approach for Treatment of Spontaneous Intradural Cervical Disc Herniation-Causing Brown-Séquard Syndrome: A 2-Dimensional Operative Video.

Intradural disc herniations (IDH) account for 0.27% of all disc herniations. Cervical IDH account for 3% of these, with only 47 cases reported in the literature, making it an extremely rare diagnosis. Brown-Séquard syndrome is the most common presentation of cervical IDH. Emergent decompression is usually necessary. We present the case of a 56-year-old woman who presented with Brown-Séquard syndrome secondary to a spontaneous intradural C5-6 disc herniation. A posterior transdural approach was recommended to arrest her neurological deficit and promote improvement. The patient consented to the procedure. Institutional Review Board approval was not necessary, given this treatment was necessary and indicated. A standard posterior cervical exposure and C5-6 laminectomies were performed. The dura was opened with a "peeling" technique. The compressive disc fragments were removed. A dural defect was identified along the C6 nerve root sleeve. Fluoroscopy was used to confirm the communication of the defect with the C5-6 disc space. A single 5-0 Prolene suture was used to repair the defect, approximating the anterior dura with a flap from the nerve root sleeve. The patient had an uneventful postoperative course. At 7-month follow-up, her neurological deficits had nearly resolved. Surgeons should consider IDH in the differential diagnosis for sudden neurologic decline in the setting of an intradural mass and should be familiar with the association between cervical IDH and Brown-Séquard syndrome. The posterior transdural approach provides excellent exposure, easier management of dural defects, and ability to handle a variety of intradural pathologies and may avoid the need for concomitant fusion.

Unveiling the role of dorsal root ganglia in spasticity reduction: Insights from contralateral seventh cervical nerve cross transfer surgery.

Central nervous system (CNS) disorders, such as stroke, often lead to spasticity, which result in limb deformities and significant reduction in quality of life. Spasticity arises from disruptions in the normal functioning of cortical and descending inhibitory pathways in the brainstem, leading to abnormal muscle contractions. Contralateral seventh cervical nerve cross transfer (CC7) surgery has been proven to effectively reduce spasticity, but the specific mechanism for its effectiveness is unclear. This study aimed to investigate the changes in the dorsal root ganglia (DRG) following CC7 surgery. A comprehensive anatomical analysis was conducted through cadaveric study and magnetic resonance imaging (MRI) study, to accurately measure the regional anatomy of the C7 DRG. DRG perfusion changes were quantitatively assessed by comparing pre- and postoperative dynamic contrast-enhanced (DCE) MRI. In CC7 surgery, the C7 nerve root on the affected side is cut close to the DRG (3.6±1.0mm), while the C7 nerve root on the healthy side is cut further away from the DRG (65.0±10.0mm). MRI studies revealed that after C7 proximal neurotomy on the affected side, there was an increase in DRG volume, vascular permeability, and perfusion; after C7 distal neurotomy on the healthy side, there was a decrease in DRG volume, with no significant changes in vascular permeability and perfusion. This study provides preliminary insights into the mechanisms of spasticity reduction following CC7 surgery, indicating that changes in the DRG, such as increased vascular permeability and perfusion, could disrupt abnormal spinal γ-circuits. The resulting high-perfusion state of DRG, possibly due to heightened neuronal activity and metabolic demands, necessitating further research to verify this hypothesis.

Post-operative morbidity after C2 nerve root sacrifice during C1-2 fixation in pediatric atlantoaxial instability

Post-operative morbidity after C2 nerve root sacrifice during C1-2 fixation in pediatric atlantoaxial instability