Cervical Nerve Root Research Articles

Nerve root morphological and functional changes after degenerative cervical myelopathy surgery: preliminary study using ultrasound and electrophysiology

A prospective observational study. To depict morphological and functional changes in the cervical nerve roots before and after spinal cord decompression surgery for degenerative cervical myelopathy (DCM). A general hospital in Japan. Thirteen DCM patients who underwent posterior spinal cord decompression surgery, laminoplasty or laminectomy, were included in this study. The neural foramen shown on MRI and the cross-sectional area (CSA) of the nerve roots on ultrasound were used to evaluate the C5 and C6 nerve roots. The compound muscle action potentials (CMAPs) of deltoid and biceps muscle were also recorded. All patients showed sensorimotor functional improvement without the postoperative C5 palsy after surgery. Foraminal stenosis and preoperative CSA of the nerve root: C4/5 foramen and C5 nerve root, C5/6 foramen and C6 nerve root, had no significant correlation (P = 0.53 and 0.08). CSA of the C5 nerve root displayed no significant change before and after surgery (P = 0.2), however, that of the C6 nerve root reduced significantly after surgery (P = 0.038). The amplitude of the deltoid and biceps CMAPs displayed no significant change before and after surgery (P = 0.05 and 0.05). The C6 nerve root CSA change was observed after spinal cord decompression surgery with functional recovery. However, deltoid and biceps CMAPs amplitude showed no significant change. Independent CSA changes on ultrasound might be useful when conducting a functional evaluation of the postoperative nerve root. The Grant of Japan Orthopaedics and Traumatology Research Foundation No. 395.

A rare variant of chronic inflammatory demyelinating polyneuropathy with autonomic dysfunction

A young hypothyroid female with history of chronic inflammatory small joint arthralgias presenting with distal sensory motor symptoms of 8 weeks duration and prominent disturbances of bladder sensations was found to have symmetric motor and distal large fibre sensory loss and blunting of perineal sensations. On evaluation was found to have a normal nerve conduction study at presentation and imaging showing hypertrophic and enhancing cervical and lumbosacral nerve roots with a positive marker of mixed connective tissue disorder on ANA profile, fitting into a diagnosis of Chronic Immune Sensorimotor Polyradiculopathy in the background of a connective tissue disorder.

Nerve ultrasound evaluation of Guillain-Barré syndrome subtypes in northern China.

Ultrasound (US) studies have demonstrated patchy enlargement of spinal and peripheral nerves in Guillain-Barré syndrome (GBS). However, whether ultrasound yields useful information for early classification of GBS has not been established. We aimed to evaluate nerve ultrasound in patients with GBS in northern China and compare the sonographic characteristics between demyelinating and axonal subtypes. Between November 2018 and October 2019, 38 hospitalized GBS patients within 3wk of disease onset and 40 healthy controls were enrolled. Ultrasonographic cross-sectional areas (CSA) of the peripheral nerves, vagus nerve, and cervical nerve roots were prospectively recorded in GBS subtypes and controls. Ultrasonographic CSA exhibited significant enlargement in most patients' nerves compared with healthy controls, most prominent in cervical nerves. The CSA tended to be larger in acute inflammatory demyelinating polyneuropathy (AIDP) than in acute motor axonal neuropathy (AMAN)/acute motor and sensory axonal neuropathy (AMSAN), especially in cervical nerves (C5: 5.9 ± 1.6 mm2 vs. 7.0 ± 1.7 mm2 , p=.042; C6: 10.5 ± 1.8 mm2 vs. 12.0 ± 2.1 mm2 , p=.033). The chi-squared test revealed significant differences in nerve enlargement in C5 (p < .001), C6 (p < .001), the proximal median nerve (p < .001), and the vagus nerve (p=.003) between GBS and controls. The vagus nerve was larger in patients with autonomic dysfunction than in patients without it (2.3 ± 1.0 mm2 vs. 1.4 ± 0.5 mm2 , p=.003). The demyelinating subtype presented with more significant cervical nerve enlargement in GBS. Vagus nerve enlargement may be a useful marker for autonomic dysfunction.

AKT answer relating to cervical spine nerve roots

AKT answer relating to cervical spine nerve roots

AKT question relating to cervical spine nerve roots

AKT question relating to cervical spine nerve roots

Risk Analysis of Needle Injury to the Long Thoracic Nerve during Ultrasound-Guided C7 Selective Nerve Root Block.

Background and Objectives: Ultrasound (US)-guided cervical selective nerve root block (SNRB) is a widely used treatment for upper limb radicular pain. The long thoracic nerve (LTN) passes through the middle scalene muscle (MSM) at the C7 level. The needle trajectory of US-guided C7 SNRB pierces the MSM, therefore indicating a high probability of injury to the LTN. We aimed to identify the LTN and to investigate the risk of needle injury to the nerve during US-guided C7 SNRB. Materials and Methods: This retrospective observational study included 30 patients who underwent US-guided SNRB at the C7 level in a university hospital. We measured the maximal cross-sectional diameter (MCSD) of the LTN and cross-sectional area (CSA) of the C7 nerve root and assessed the injury risk of LTN during US-guided C7 SNRB by simulating the trajectory of the needle in the ultrasound image. Results: The LTN was detectable in all the cases, located inside and outside the MSM in 19 (63.3%) and 11 (36.7%) of cases, respectively. The LTN’s mean MCSD was 2.10 mm (SD 0.13), and the C7 root’s CSA was 10.78 mm2 (SD 1.05). The LTN location was within the simulated risk zone in 86.7% (26/30) of cases. Conclusion: Our findings suggest a high potential for LTN injury during US-guided C7 SNRB. The clear visualization of LTNs in the US images implies that US guidance may help avoid nerve damage and make the procedure safer. When performing US-guided C7 SNRB, physicians should take into consideration the location of the LTN.

Manual Therapy as a Management of Cervical Radiculopathy: A Systematic Review.

Background Cervical radiculopathy is defined as a disorder involving dysfunction of the cervical nerve roots characterised by pain radiating and/or loss of motor and sensory function towards the root affected. There is no consensus on a good definition of the term. In addition, the evidence regarding the effectiveness of manual therapy in radiculopathy is contradictory. Objective To assess the effectiveness of manual therapy in improving pain, functional capacity, and range of motion in treating cervical radiculopathy with and without confirmation of altered nerve conduction. Methods Systematic review of randomised clinical trials on cervical radiculopathy and manual therapy, in PubMed, Web of Science, Scopus, PEDro, and Cochrane Library Plus databases. The PRISMA checklist was followed. Methodological quality was evaluated using the PEDro scale and RoB 2.0. tool. Results 17 clinical trials published in the past 10 years were selected. Manual therapy was effective in the treatment of symptoms related to cervical radiculopathy in all studies, regardless of the type of technique and dose applied. Conclusions This systematic review did not establish which manual therapy techniques are the most effective for cervical radiculopathy with electrophysiological confirmation of altered nerve conduction. Without this confirmation, the application of manual therapy, regardless of the protocol applied and the manual therapy technique selected, appears to be effective in reducing chronic cervical pain and decreasing the index of cervical disability in cervical radiculopathy in the short term. However, it would be necessary to agree on a definition and diagnostic criteria of radiculopathy, as well as the definition and standardisation of manual techniques, to analyse the effectiveness of manual therapy in cervical radiculopathy in depth.

Usefulness of Simultaneous Magnetic Resonance Neurography and Apparent T2 Mapping for the Diagnosis of Cervical Radiculopathy.

Study DesignRetrospective observational study.PurposeWe investigated the correlation between T2 relaxation times and clinical symptoms in patients with cervical radiculopathy caused by cervical disk herniation.Overview of LiteratureThere are currently no imaging modalities that can assess the affected cervical nerve roots quantitatively.MethodsA total of 14 patients with unilateral radicular symptoms and five healthy subjects were subjected to simultaneous apparent T2 mapping and neurography with nerve-sheath signal increased with inked rest-tissue rapid acquisition of relaxation enhancement signaling (SHINKEI-Quant) using a 3-Tesla magnetic resonance imaging. The Visual Analog Scale (VAS) score for neck pain and upper arm pain was used to evaluate clinical symptoms. T2 relaxation times of the cervical dorsal root ganglia of the brachial plexus were measured bilaterally from C4 to C8 in patients with radicular symptoms and from C5 to C8 in healthy controls. The T2 ratio was calculated as the affected side to unaffected side.ResultsWhen comparing nerve roots bilaterally at each spinal level, no significant differences in T2 relaxation times were found between patients and healthy subjects. However, T2 relaxation times of nerve roots in the patients with unilateral radicular symptoms were significantly prolonged on the involved side compared with the uninvolved side (p<0.05). The VAS score for upper arm pain was not significantly correlated with the T2 relaxation times, but was positively correlated with the T2 ratio.ConclusionsIn patients with cervical radiculopathy, the SHINKEI-Quant technique can be used to quantitatively evaluate the compressed cervical nerve roots. The VAS score for upper arm pain was positively correlated with the T2 ratio. This suggests that the SHINKEI-Quant is a potential tool for the diagnosis of cervical nerve entrapment.

Coblation Discoplasty Alleviates Cervical Chest Pain After Positive Ultrasound-Guided Nerve Root Block: A Retrospective Study

Cervical chest pain (CCP), as 1 atypical symptom associated with cervical spondylosis, often overlaps with other chest-related diseases. CCP obviously relieved after ultrasound-guided cervical nerve root block near a herniated disc should be considered as a potential pathologic source. The purpose of this study is to investigate whether coblation discoplasty can alleviate CCP after positive ultrasound-guided nerve root block. From August 2016 to September 2019, 21 patients with high suspicion of CCP experienced over 50% pain relieve after ultrasound-guided diagnostic nerve root block. Through 12 months of follow-up, the primary efficacy was assessed with visual analogue scale (VAS) of CCP, and secondary outcomes included: neck pain VAS, neck disability index (NDI), the proportion of significant CCP relief, the rating of CCP alleviation, the patient satisfaction index (PSI), and analgesic consumption. Adverse events were recorded to evaluate safety. Following postoperative 12 months, a time-course analysis confirmed a robust decline in VAS of CCP (P < 0.0001), and a similar recovery trend was shown in VAS of neck pain and NDI (P < 0.0001). After treatment, the number of patients taking analgesics decreased (P < 0.0001), and around 60% of patients reported notable relief and satisfaction with treatment. No serious complications were observed. After positive ultrasound-guided nerve root block, coblation discoplasty can provide up to 12 months of relief for intractable CCP.

A study of ultrasound-guided perineural injection of the caudal cervical spinal nerve roots in equine cadavers

ObjectivesTo develop an ultrasound-guided cervical perineural injection technique for horses and to evaluate and compare the distribution of contrast agent among perineural, intra-articular and periarticular injections. Study designProspective, experimental cadaveric study. AnimalsA total of 14 equine cadaveric necks. MethodsBilateral ultrasound-guided perineural injection technique for the caudal cervical spinal nerve roots (CSNRs 5–7) was developed. Paramagnetic or iodinated contrast was injected and the distribution of contrast was evaluated using magnetic resonance (MR) or computed tomography (CT) imaging, respectively. The presence of contrast in the CSNR region was determined by an observer unaware of the technique used for each injection performed. The ability of the perineural injection technique to distribute contrast agent to the CSNR region was compared with intra-articular and periarticular injection techniques. ResultsPerineural injection delivered contrast agent to the CSNR region 100% of the time and was significantly different when compared with intra-articular injection (p = 0.008). There was no difference in ability to deliver contrast agent to the CSNR region between the perineural and periarticular injection techniques or between the intra-articular and periarticular injection techniques. Conclusion and clinical relevanceThe ultrasound-guided perineural injection technique developed in this study accurately delivered contrast agent to the CSNR region in equine cadavers. This technique could potentially be used for the diagnosis and treatment of cervical pain in horses, particularly in cases where intra-articular cervical articular process joint injections have not been beneficial. Further studies are necessary to assess the effectiveness of the ultrasound-guided perineural injection technique in live horses.

Cross-sectional area reference values for peripheral nerve ultrasound in adults: A systematic review and meta-analysis-Part III: Cervical nerve roots and vagal nerve.

Measurement of the cross-sectional area (CSA) of cervical nerve roots using ultrasound is useful in the evaluation of inflammatory polyneuropathies, and measurement of CSA of the vagal nerve might give information about involvement of the autonomic nervous system. We performed a systematic review and meta-analysis of published CSA reference values for cervical nerve roots and vagal nerve. We included available-to-date nerve ultrasound studies on healthy adults and provide meta-analysis for CSA of the following nerves: cervical nerve roots C5, C6, and C7 as well as vagal nerve in the carotid sheath at the carotid bifurcation level. We report regression and correlation analyses for age, gender, height, weight, and geographic continent. We included 11 studies with 885 healthy volunteers (mean age=42.7years) and 3149 examined nerve sites. Calculated mean pooled CSA of C5 root was 5.6mm2 (95% confidence interval [CI]=4.6-6.7mm2 , n=911), of C6 root was 8.8mm2 (95% CI=7.4-10.3mm2 , n=909), of C7 root was 9.5mm2 (95% CI=8.0-10.9mm2 , n=909), and of vagal nerve was 2.2mm2 (95% CI=1.5-2.9mm2 , n=420). No heterogeneity was found across studies for any site. Subgroup analysis revealed no significant effects of age, gender, height, weight, and geographic continent on CSA for any of these nerve sites. We provide the first meta-analysis on CSA reference values for the cervical nerve roots and the vagal nerve, with no heterogeneity of reported CSA values at all nerve sites. Our data facilitate the goal of an international standardized evaluation protocol.

Is Abnormal Electrodiagnostic Finding Related to the Cross-Sectional Area of the Nerve Root in Cervical Radiculopathy?

Objective To assess the relevance of electrodiagnosis (EDX) in the cross-sectional area (CSA) of the nerve root of patients with cervical radiculopathy (CR) by using high-resolution ultrasonography (HRUS).MethodsThe CSAs of the cervical nerve roots at C5, C6, and C7 were measured bilaterally using HRUS in 29 patients with unilateral CR whose clinical symptoms, magnetic resonance imaging (MRI) findings, and EDX results corresponded with each other (CR-A group), and in 26 patients with unilateral CR whose clinical symptoms and MRI findings matched with each other but did not correspond with the EDX findings (CR-B group). ResultsThe CSA of the affected side in each nerve root was significantly larger than that of the unaffected side in both the CR-A and CR-B groups. The side-to-side difference in the bilateral CSAs of the nerve root and the ratio of the CSAs between the unaffected and affected sides were statistically larger in the CR-A group than in the CR-B group.ConclusionThe increased CSAs in the CR-A group reflect the physiological changes of the cervical nerve root, which is supported by the EDX findings.

Clinical Correlation of Change in Sagittal Parameters after Anterior Cervical Microdiscectomy

Objective: Cervical radiculopathy is the syndrome of pain and / or sensorimotor deficit caused by compression of the cervical nerve root. Symptoms of cervical radiculopathy in the upper limb are described as pain, numbness, or weakness. Conservative treatment is recommended initially for degenerative cervical radiculopathy. Surgical treatment is recommended in cases where progressive loss of muscle strength does not respond to conservative therapy. Many radiographic parameters are used to define the sagittal alignment of the cervical spine. This variation contrasts with the assessment of caudal spine segments where there are more established guides for measuring deformity angles. The aim of this study is to evaluate the effect of anterior cervical discectomy and fusion, which are widely used in spinal surgery practice, on cervical sagittal alignment.Methods: We retrospectively evaluated 33 patients who were operated with anterior cervical discectomy and fusion technique with the diagnosis of single level degenerative cervical disc hernia after an average of 3 months of follow-up period. For radiological evaluation, we analyzed the C2-C7 lordosis angles, the anterior and posterior disc heights at the operating level on lateral scoliosis radiographs, preoperatively and at 3rd month postoperatively. Japanese Orthopedic Association scores and visual analog scale scores were examined to evaluate clinical results.Results: A statistically significant difference was found between the preoperative radiological sagittal parameters and the postoperative 3rd month (p = 0.001). When the clinical correlation of the findings was examined, a statistically significant difference was found in the Japanese Orthopedic Association scores and visual analog scale scores of the patients measured preoperatively versus 3 months postoperatively (p &amp;lt; 0.001).Conclusion: Radiological and clinical parameters improve significantly in patients after single level anterior cervical discectomy surgery.

Nerve ultrasound studies in POEMS syndrome.

The aim of our study was to assess the ultrasonographic features of peripheral nerves in patients with POEMS (polyneuropathy, organomegaly, endocrinopathy, M protein, and skin changes) syndrome. 34 POEMS syndrome patients and 26 healthy control (HC) participants were recruited prospectively. Cross-sectional area (CSA) was measured in nerves of limbs, trunks of brachial plexus, and cervical nerve roots RESULTS: The CSAs were mildly enlarged at the arm segment of median nerve, elbow segment of ulnar nerve and upper trunk, moderately enlarged at the forearm segment of both median and ulnar nerve, upper trunk of brachial plexus, and C6, C7 cervical nerve roots, and markedly enlarged at the arm segment of ulnar nerve, middle and lower trunk of brachial plexus, as well as C5 cervical root. The CSAs of upper limb nerves were larger in POEMS syndrome patients than in HCs, and the enlargements were most prominent proximally.

Radicular arm pain.

Cervical radiculopathy is a neurological condition caused by dysfunction or compression of a cervical nerve root. Patients often report unilateral neck pain with radiation to the ipsilateral arm, often with sensory changes in a dermatomal distribution. Weakness and reflex changes are also commonly found and can be very troubling for patients. Careful history and examination is important to identify any more concerning features such as progressive symptoms and features of myelopathy, which could prompt surgical management. Although the majority of patients will see an improvement in their symptoms over time with conservative management, surgery is indicated in patients with debilitating pain, progressive neurology, significant weakness, instability or myelopathy. Advancements in surgical techniques offer a range of potential operations that should be considered carefully for each patient. This article outlines the clinical approach to presentation, pathophysiology, diagnosis and management.

Larger pain extent is associated with greater pain intensity and disability but not with general health status or psychosocial features in patients with cervical radiculopathy.

Pain as a result of cervical radiculopathy (CR) can be widespread, nondermatomal and individually specific, but the association between pain extent and other clinical features has never been explored. The objective of this study is to investigate whether pain extent relates to clinical variables including pain intensity in addition to health indicators including disability, general health, depression, somatic anxiety, coping strategies or self-efficacy.An observational cohort study was conducted. Participants were recruited from 4 hospital spinal centres in Sweden. Pain extent was quantified from the pain drawings of 190 individuals with cervical disc disease, verified with magnetic resonance imaging (MRI) and compatible with clinical findings (examined by a neurosurgeon), that show cervical nerve root compression. Pain extent was evaluated in relation to neck pain, arm pain, and headache intensity. Multiple linear regression analysis were then used to verify whether pain extent was associated with other health indicators including disability, health-related quality of life, depression, somatic anxiety, coping strategies and self-efficacy.Pain extent was directly related to neck, arm and headache pain intensity (all P < .01). Multiple linear regression revealed that pain extent was significantly associated only to the level of perceived disability (P < .01).Increased pain extent in people with CR is associated with higher headache, neck and arm pain intensity, and disability but not measures of general health, depression, somatic anxiety, coping strategies or self-efficacy.

An Audit of Dysphagia Patients Attending Speech Therapy Clinic at a Tertiary Hospital in Malaysia

Swallowing involves 55 muscles, five cranial nerves and two cervical nerve roots. When the coordination of this reflex is disturbed, dysphagia occurs. Dysphagia refers either to the difficulty someone may have with the initial phases of a swallow or to the sensation that the foods or the liquids are being obstructed in their passage from the mouth to the stomach. The objective of the study was to identify the diagnosis of patients attending Speech Therapy clinic, in Queen Elizabeth Hospital, Kota Kinabalu, Sabah, and to identify the demography of dysphagic patients. From the 406 patients that came during the study period, 139 patients (34.2%) were diagnosed with dysphagia, followed by developmental language disorders (33.3%). Of the 139 patients diagnosed with dysphagia, most of them are within the 41 to 60 (43.2%) and above 60 (42.2%) age groups. The majority were males (66.2%). A total of 81 (58.3%) patients with dysphagia had a history of cerebrovascular accident. Dysphagia is a common disorder among patients attending Speech Therapy Clinics at Queen Elizabeth Hospital, Kota Kinabalu. Training of Speech Therapists and early dysphagia intervention leads to a better outcome.

US-Guided Transforaminal Cervical Nerve Root Block: A Novel Lateral in-Plane Approach.

The aim of the present study was to investigate the effectiveness and safety of a novel lateral in-plane approach for ultrasound-guided transforaminal cervical nerve root block (US-guided TF-CNRB) in the treatment of cervical radiculopathic pain. The design of the present study consisted of an institutional, retrospective case series. The present study was conducted at a university hospital. Thirty-two patients with cervical radiculopathy who were resistant to conservative therapies and regular US-guided CNRB were included as participants. The included patients were treated with US-guided TF-CNRB. During the treatments, using real-time fluoroscopy, we monitored the spreading patterns of a contrast medium and double confirmed the positions of needle tips. Pain numeric rating scales (NRS) and symptom relief grades were determined via telephone interviews at one, four, and 12 weeks after the procedures. US-guided TF-CNRB was performed at the C5 level in six patients, the C6 level in 18 patients, and the C7 level in eight patients. Compared with NRS at baseline, pain scores decreased throughout the observation period. Symptom relief rates of US-guided TF-CNRB at one, four, and 12 weeks were 72%, 69%, and 63%, respectively. Venous blood was aspirated during the procedures in two patients, and the needle tips were corrected. No intravascular injections or neurologic injuries were observed. US-guided TF-CNRB produced circumferential spreading around the involved cervical nerve root and showed significant clinical effectiveness in patients resistant to regular US-guided CNRB.

Intra- and Inter-Observer Variability in Sonographic Measurement of the Cervical Nerve Roots of Healthy Volunteers

Aim: The aim of our study is to determine the normal values of mean cervical (C) nerve root diameter in millimeters (mm) in healthy volunteers and to show its relationship to age, gender, height, weight, body mass index (BMI), and the dominant hand.Material and Method: Two observers measured the mean nerve root diameter of the bilateral C5, C6, and C7 nerve of all volunteers. Before the procedure, the age, sex, height, weight, BMI, and the dominant hand of all the participants were noted. Two measurements were taken by each of the two observers without one knowing about the other’s noted values. The intraclass correlation coefficient (ICC) test was used to analyze intra-and inter-observer reliability.Results: There was no statistically significant relationship between gender and dominant hand, and mean nerve root diameter. Moreover, when we compared the mean nerve root diameter for the nerves in the right and left sides of each participant, no significant statistical differences were identified. The mean diameter of the C6 nerve root was higher than that of C7, which was higher than that of C5 on both sides (p &amp;lt; 0.001). The ICC values for intra- and inter-observer were good or excellent for all diameter measurements (ICC &amp;gt; 0.8).Conclusions: The normal range of cervical nerve root diameters should be determined to distinguish pathological conditions. In our study, the measurement of mean nerve root diameters of C5, C6, and C7 nerves is highly reproducible with excellent intra-observer and inter-observer agreement. Therefore, the measurement of nerve root diameter can be confidently performed in daily clinical practice.

Cervical spondylosis as a possible hidden reason beyond delayed phrenic nerve distal motor latency

BackgroundCervical spondylosis is a chronic degenerative condition of the cervical spine that can affect the cervical nerve roots. The origin of the phrenic nerve makes it vulnerable to injury. The purpose of this study is to investigate possible subtle phrenic nerve affection in patients with cervical spondylosis using nerve conduction studies (NCS). This study was conducted on 30 patients with cervical spondylosis above C5 and on 30 healthy volunteers. Nerve conduction studies of both phrenic nerves were performed in all cases.ResultsThe patients with cervical spondylosis showed a statistically highly significant prolongation of phrenic nerve distal motor latency (DML) than the control group (P < 0.01). There was no significant difference regarding amplitude (P > 0.05). There was a significant correlation between DML and X-ray score (r < 0.05).ConclusionsCervical spondylosis is an underestimated cause of phrenic nerve delayed DML. There is a correlation between the delay of phrenic nerve DML and the severity of cervical spondylosis.