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Cuendet D, Valsecchi D, Najberg H, Maestretti G, Medlin F. Neuromuscular ultrasound changes in unilateral symptomatic subacute lumbosacral radiculopathy: A prospective simple blinded cohort study. Muscle Nerve 2024; 69:566-571. [PMID: 38390643 DOI: 10.1002/mus.28061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 01/21/2024] [Accepted: 01/26/2024] [Indexed: 02/24/2024]
Abstract
INTRODUCTION/AIMS Lumbosacral radiculopathy (LR) is a common disorder. Neuromuscular ultrasound (NMU) is a rapidly evolving technique for the investigation of peripheral nerve and muscle disorders, but studies using NMU in LR are lacking. The aim of the present study was to investigate ultrasonographic neuromuscular changes distant from root compression in patients with subacute to chronic compressive LR with motor impairment. METHODS Patients with unilateral subacute to chronic L4, L5, or S1 radiculopathy with motor impairment and confirmed by magnetic resonance imaging were included. The sciatic and femoral nerve cross-sectional areas (CSA), the CSA of lower limb muscles, and muscle fasciculation detection rate were assessed using a pre-specified neuromuscular ultrasound evaluation with blinded side-to-side comparison. RESULTS Of the 18 included patients, 66% were male and the mean age was 51 years. Overall, 16.7% had L4, 55.5% L5, and 27.8% S1 radiculopathy, mostly due to disc herniation (83%). Sciatic nerve CSA of the symptomatic side was increased (61.4 mm2 vs. 51.3 mm2; p = .001), and the fasciculation detection rate was higher in the affected muscles (delta = 13%, p = .007) compared to unaffected ones. Muscle CSA in affected and nonaffected muscles was decreased on the symptomatic side. DISCUSSION NMU evaluation in patients with symptomatic subacute to chronic LR revealed sciatic nerve enlargement distant from nerve root compression and higher fasciculation rates. These structural findings on NMU might be due to an axonal repair mechanism and an inflammatory response with endoneurial edema induced by ongoing nerve damage and potentially reflect progressive axonal loss.
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Affiliation(s)
- David Cuendet
- Neurology Unit, Department of Internal Medicine, Cantonal Hospital Fribourg, Fribourg, Switzerland
- Faculty of Science and Medicine, University Fribourg, Fribourg, Switzerland
| | - Daniele Valsecchi
- Faculty of Science and Medicine, University Fribourg, Fribourg, Switzerland
- Neuro-spinal Unit, Department of Orthopedics surgery and Traumatology, Cantonal Hospital Fribourg, Fribourg, Switzerland
| | - Hugo Najberg
- Faculty of Science and Medicine, University Fribourg, Fribourg, Switzerland
| | - Gianluca Maestretti
- Faculty of Science and Medicine, University Fribourg, Fribourg, Switzerland
- Neuro-spinal Unit, Department of Orthopedics surgery and Traumatology, Cantonal Hospital Fribourg, Fribourg, Switzerland
| | - Friedrich Medlin
- Neurology Unit, Department of Internal Medicine, Cantonal Hospital Fribourg, Fribourg, Switzerland
- Faculty of Science and Medicine, University Fribourg, Fribourg, Switzerland
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Additional benefit of ultrasonography to evaluate nerve root condition of degenerative cervical spine disease. Spinal Cord 2023; 61:69-75. [PMID: 36316546 DOI: 10.1038/s41393-022-00865-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 10/10/2022] [Accepted: 10/12/2022] [Indexed: 01/13/2023]
Abstract
STUDY DESIGN A cross-sectional explanatory study. OBJECTIVES To clarify the nerve root condition and the association between nerve root cross-sectional area (CA) on ultrasonography (US) and other examinations such as MRI or compound muscle action potentials (CMAPs) in degenerative cervical spine diseases. SETTING A university hospital in Japan. METHODS Fifty-one patients diagnosed with proximal cervical spondylotic amyotrophy (CSA) (13 patients), cervical radiculopathy of C5 or C6 nerve root (CR) (26 patients), or cervical spondylotic myelopathy (CSM) (12 patients), and twenty-nine healthy volunteers were included in this study. Neurological findings, US findings and CMAPs of deltoid and biceps muscles of all participants were evaluated. In addition, CSA, CR, and CSM patients underwent MRI. RESULTS A significant correlation was not observed between CA and CMAP amplitude or foraminal diameter on MRI (P > 0.05). In the US examination, the C6 CA of the affected side of the CR group was significantly larger than that of both the normal side and the other groups (P < 0.001). The C5 CA of the affected side of the CSA group clearly showed a bimodal distribution: enlarged and small CA groups. In the CMAP findings, CSA cases respectively showed the lower amplitude of deltoid and bicep CMAPs on both the normal and the affected side (P ≦ 0.01). CSM and healthy volunteers were nearly identical in CA and CMAPs. CONCLUSION Utilizing US in addition to NCS and MRI can contribute towards an evaluation of the nerve root condition of degenerative cervical spine disease. SPONSORSHIP no sponsorship.
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Ultrasound of cervical nerve root enlargement in polyneuropathy is not confounded by neuroforaminal stenoses. Clin Neurophysiol 2022; 141:34-41. [DOI: 10.1016/j.clinph.2022.06.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 06/21/2022] [Accepted: 06/25/2022] [Indexed: 11/22/2022]
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Tadokoro N, Hashimoto K, Yanagawa Y, Maehara H, Sano T. Nerve root morphological and functional changes after degenerative cervical myelopathy surgery: preliminary study using ultrasound and electrophysiology. Spinal Cord 2021; 60:301-305. [PMID: 34556821 DOI: 10.1038/s41393-021-00707-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 09/10/2021] [Accepted: 09/13/2021] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN A prospective observational study. OBJECTIVES To depict morphological and functional changes in the cervical nerve roots before and after spinal cord decompression surgery for degenerative cervical myelopathy (DCM). SETTING A general hospital in Japan. METHODS 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. RESULTS 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). CONCLUSION 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. SPONSORSHIP The Grant of Japan Orthopaedics and Traumatology Research Foundation No. 395.
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Affiliation(s)
- Nobuaki Tadokoro
- Department of Orthopaedic surgery, Kochi prefectural Hata Kenmin hospital, Sukumo, Kochi, Japan
| | - Kyuichi Hashimoto
- Department of Orthopaedic surgery, Kochi prefectural Hata Kenmin hospital, Sukumo, Kochi, Japan
| | - Yuki Yanagawa
- Department of Orthopaedic surgery, Kochi prefectural Hata Kenmin hospital, Sukumo, Kochi, Japan
| | - Haruka Maehara
- Department of Orthopaedic surgery, Kochi prefectural Hata Kenmin hospital, Sukumo, Kochi, Japan
| | - Toshihiro Sano
- Department of Orthopaedic surgery, Kochi prefectural Hata Kenmin hospital, Sukumo, Kochi, Japan.
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Fisse AL, Katsanos AH, Gold R, Pitarokoili K, Krogias C. 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. Eur J Neurol 2021; 28:2319-2326. [PMID: 33838065 DOI: 10.1111/ene.14862] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 03/28/2021] [Accepted: 04/07/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND PURPOSE 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. METHODS 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. RESULTS We included 11 studies with 885 healthy volunteers (mean age = 42.7 years) and 3149 examined nerve sites. Calculated mean pooled CSA of C5 root was 5.6 mm2 (95% confidence interval [CI] = 4.6-6.7 mm2 , n = 911), of C6 root was 8.8 mm2 (95% CI = 7.4-10.3 mm2 , n = 909), of C7 root was 9.5 mm2 (95% CI = 8.0-10.9 mm2 , n = 909), and of vagal nerve was 2.2 mm2 (95% CI = 1.5-2.9 mm2 , 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. CONCLUSIONS 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.
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Affiliation(s)
- Anna Lena Fisse
- Department of Neurology, St. Josef Hospital, Ruhr University Bochum, Bochum, Germany.,Immunmediated Neuropathies Biobank (INHIBIT), Ruhr University Bochum, Bochum, Germany
| | - Aristeidis H Katsanos
- Division of Neurology, McMaster University/Population Health Research Institute, Hamilton, ON, Canada
| | - Ralf Gold
- Department of Neurology, St. Josef Hospital, Ruhr University Bochum, Bochum, Germany.,Immunmediated Neuropathies Biobank (INHIBIT), Ruhr University Bochum, Bochum, Germany
| | - Kalliopi Pitarokoili
- Department of Neurology, St. Josef Hospital, Ruhr University Bochum, Bochum, Germany.,Immunmediated Neuropathies Biobank (INHIBIT), Ruhr University Bochum, Bochum, Germany
| | - Christos Krogias
- Department of Neurology, St. Josef Hospital, Ruhr University Bochum, Bochum, Germany
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Jeoung J, Choi HS, Woo SR, Kang S, Yoon JS. Is Abnormal Electrodiagnostic Finding Related to the Cross-Sectional Area of the Nerve Root in Cervical Radiculopathy? Ann Rehabil Med 2021; 45:116-122. [PMID: 33985315 PMCID: PMC8137382 DOI: 10.5535/arm.20172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 10/08/2020] [Indexed: 11/29/2022] Open
Abstract
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). Methods The 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). Results The 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. Conclusion The increased CSAs in the CR-A group reflect the physiological changes of the cervical nerve root, which is supported by the EDX findings.
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Affiliation(s)
- JuHyong Jeoung
- Department of Physical Medicine and Rehabilitation, Korea University Guro Hospital, Seoul, Korea
| | - Hyuk Sung Choi
- Department of Physical Medicine and Rehabilitation, Korea University Guro Hospital, Seoul, Korea
| | - Sang Rok Woo
- Department of Physical Medicine and Rehabilitation, Korea University Guro Hospital, Seoul, Korea
| | - Seok Kang
- Department of Physical Medicine and Rehabilitation, Korea University Guro Hospital, Seoul, Korea
| | - Joon Shik Yoon
- Department of Physical Medicine and Rehabilitation, Korea University Guro Hospital, Seoul, Korea
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Drake-Pérez M, Pelayo-Negro AL, Sánchez-de la Torre JR, Berciano J, Gallardo E. Ultrasonography of cervical nerve roots: cross-sectional reference values according to age. Neurol Sci 2020; 42:215-223. [PMID: 32617742 DOI: 10.1007/s10072-020-04551-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2019] [Accepted: 06/25/2020] [Indexed: 11/26/2022]
Abstract
INTRODUCTION The aim of this study is to describe the normal cross-sectional area (CSA) and appearance of cervical nerve roots in ultrasound, correlating it to age and other patient somatic parameters. METHODS One hundred healthy volunteers were included. We aimed to achieve uniform representation throughout all age groups. Ultrasound of the cervical nerve roots was performed bilaterally. CSA and margins description were obtained. RESULTS C5 nerve, 8.32 ± 2.30; C6 nerve, 11.88 ± 3.36; C7 nerve, 12.79 ± 3.85; C8 nerve, 11.20 ± 3.45. Significant correlation between CSA and age was demonstrated, but not for body mass index. Blurred margins were present in up to 23.71% cervical nerves, more frequently in older individuals and in C7 nerve. DISCUSSION If ultrasound morphology of cervical nerve roots is used as a diagnostic parameter, the normal range of CSA values and percentage of blurred margins according to age should be considered.
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Affiliation(s)
- Marta Drake-Pérez
- Service of Radiology, University Hospital "Marqués de Valdecilla (IDIVAL)", 39008, Santander, Spain.
| | - Ana L Pelayo-Negro
- Service of Neurology, University Hospital "Marqués de Valdecilla (IDIVAL)", University of Cantabria and "Centro de Investigación Biomédica en Red de Enfermedades Neurodegenerativas (CIBERNED)", Santander, Spain
| | | | - José Berciano
- Service of Neurology, University Hospital "Marqués de Valdecilla (IDIVAL)", University of Cantabria and "Centro de Investigación Biomédica en Red de Enfermedades Neurodegenerativas (CIBERNED)", Santander, Spain
| | - Elena Gallardo
- Service of Radiology, University Hospital "Marqués de Valdecilla (IDIVAL)", University of Cantabria and "Centro de Investigación Biomédica en Red de Enfermedades Neurodegenerativas (CIBERNED)", Santander, Spain
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Halligan S, Kenis SF, Abeyakoon O, Plumb AAO, Mallett S. How to avoid describing your radiological research study incorrectly. Eur Radiol 2020; 30:4648-4655. [PMID: 32086575 PMCID: PMC7338281 DOI: 10.1007/s00330-020-06720-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Accepted: 02/05/2020] [Indexed: 12/04/2022]
Abstract
Abstract This review identifies and examines terms used to describe a radiological research “study” or “trial”. A taxonomy of clinical research descriptions is explained with reference to medical imaging examples. Because many descriptive terms have precise methodological implications, it is important that these terms are understood by readers and used correctly by researchers, so that the reader is not misled. Key Points • Multiple different terms are being used to describe radiological research “studies” and “trials”, and many of these terms have precise methodological implications. • Radiological researchers sometimes use titles that describe their research incorrectly. This can mislead the reader as to what was actually done. • It is important that readers and researchers understand the correct taxonomy of clinical research and that researchers adopt the correct description for their work.
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Affiliation(s)
- Steve Halligan
- Centre for Medical Imaging, University College London UCL, Charles Bell House, 43-45 Foley Street, London, W1W 7TS, UK.
| | - Shedrack F Kenis
- Centre for Medical Imaging, University College London UCL, Charles Bell House, 43-45 Foley Street, London, W1W 7TS, UK
| | - Oshaani Abeyakoon
- Centre for Medical Imaging, University College London UCL, Charles Bell House, 43-45 Foley Street, London, W1W 7TS, UK
| | - Andrew A O Plumb
- Centre for Medical Imaging, University College London UCL, Charles Bell House, 43-45 Foley Street, London, W1W 7TS, UK
| | - Susan Mallett
- Institute of Applied Health Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
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Telleman JA, Herraets IJT, Goedee HS, Verhamme C, Nikolakopoulos S, van Asseldonk JTH, van der Pol WL, van den Berg LH, Visser LH. Nerve ultrasound: A reproducible diagnostic tool in peripheral neuropathy. Neurology 2019; 92:e443-e450. [PMID: 30593519 DOI: 10.1212/wnl.0000000000006856] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Accepted: 10/01/2018] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE To determine interobserver variability of nerve ultrasound in peripheral neuropathy in a prospective, systematic, multicenter study. METHODS We enrolled 20 patients with an acquired chronic demyelinating or axonal polyneuropathy and 10 healthy controls in 3 different centers. All participants underwent an extensive nerve ultrasound protocol, including cross-sectional area measurements of median, ulnar, fibular, tibial, and sural nerves, and brachial plexus. Real-time image acquisition was performed blind by a local and a visiting investigator (reference). Five patients were investigated using different types of sonographic devices. Intraclass correlation coefficients were calculated, and a random-effects model was fitted to identify factors with significant effect on interobserver variability. RESULTS Systematic differences between measurements made by different investigators were small (mean difference 0.11 mm2 [95% confidence interval 0.00-0.23 mm2]). Intraclass correlation coefficients were generally higher in arm nerves (0.48-0.96) than leg nerves (0.46-0.61). The hospital site and sonographic device did not contribute significantly to interobserver variability in the random-effects model. CONCLUSIONS Interobserver variability of nerve ultrasound in peripheral neuropathy is generally limited, especially in arm nerves. Different devices and a multicenter setting have no effect on interobserver variability. Therefore, nerve ultrasound is a reproducible tool for diagnostics in routine clinical practice and (multicenter) research.
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Affiliation(s)
- Johan A Telleman
- From the Department of Neurology and Clinical Neurophysiology (J.A.T., I.J.T.H., J.-T.H.v.A., L.H.V.), Elisabeth-Tweesteden Hospital, Tilburg; Department of Neurology and Neurosurgery (J.A.T., I.J.T.H., H.S.G., W.L.v.d.P., L.H.v.d.B.), Brain Center Rudolf Magnus, UMC Utrecht; Department of Neurology and Clinical Neurophysiology (C.V.), Academic Medical Center, Amsterdam; and Department of Biostatistics (S.N.), Julius Center for Health Sciences and Primary Care, UMC Utrecht, the Netherlands
| | - Ingrid J T Herraets
- From the Department of Neurology and Clinical Neurophysiology (J.A.T., I.J.T.H., J.-T.H.v.A., L.H.V.), Elisabeth-Tweesteden Hospital, Tilburg; Department of Neurology and Neurosurgery (J.A.T., I.J.T.H., H.S.G., W.L.v.d.P., L.H.v.d.B.), Brain Center Rudolf Magnus, UMC Utrecht; Department of Neurology and Clinical Neurophysiology (C.V.), Academic Medical Center, Amsterdam; and Department of Biostatistics (S.N.), Julius Center for Health Sciences and Primary Care, UMC Utrecht, the Netherlands
| | - H Stephan Goedee
- From the Department of Neurology and Clinical Neurophysiology (J.A.T., I.J.T.H., J.-T.H.v.A., L.H.V.), Elisabeth-Tweesteden Hospital, Tilburg; Department of Neurology and Neurosurgery (J.A.T., I.J.T.H., H.S.G., W.L.v.d.P., L.H.v.d.B.), Brain Center Rudolf Magnus, UMC Utrecht; Department of Neurology and Clinical Neurophysiology (C.V.), Academic Medical Center, Amsterdam; and Department of Biostatistics (S.N.), Julius Center for Health Sciences and Primary Care, UMC Utrecht, the Netherlands
| | - Camiel Verhamme
- From the Department of Neurology and Clinical Neurophysiology (J.A.T., I.J.T.H., J.-T.H.v.A., L.H.V.), Elisabeth-Tweesteden Hospital, Tilburg; Department of Neurology and Neurosurgery (J.A.T., I.J.T.H., H.S.G., W.L.v.d.P., L.H.v.d.B.), Brain Center Rudolf Magnus, UMC Utrecht; Department of Neurology and Clinical Neurophysiology (C.V.), Academic Medical Center, Amsterdam; and Department of Biostatistics (S.N.), Julius Center for Health Sciences and Primary Care, UMC Utrecht, the Netherlands
| | - Stavros Nikolakopoulos
- From the Department of Neurology and Clinical Neurophysiology (J.A.T., I.J.T.H., J.-T.H.v.A., L.H.V.), Elisabeth-Tweesteden Hospital, Tilburg; Department of Neurology and Neurosurgery (J.A.T., I.J.T.H., H.S.G., W.L.v.d.P., L.H.v.d.B.), Brain Center Rudolf Magnus, UMC Utrecht; Department of Neurology and Clinical Neurophysiology (C.V.), Academic Medical Center, Amsterdam; and Department of Biostatistics (S.N.), Julius Center for Health Sciences and Primary Care, UMC Utrecht, the Netherlands
| | - Jan-Thies H van Asseldonk
- From the Department of Neurology and Clinical Neurophysiology (J.A.T., I.J.T.H., J.-T.H.v.A., L.H.V.), Elisabeth-Tweesteden Hospital, Tilburg; Department of Neurology and Neurosurgery (J.A.T., I.J.T.H., H.S.G., W.L.v.d.P., L.H.v.d.B.), Brain Center Rudolf Magnus, UMC Utrecht; Department of Neurology and Clinical Neurophysiology (C.V.), Academic Medical Center, Amsterdam; and Department of Biostatistics (S.N.), Julius Center for Health Sciences and Primary Care, UMC Utrecht, the Netherlands
| | - W Ludo van der Pol
- From the Department of Neurology and Clinical Neurophysiology (J.A.T., I.J.T.H., J.-T.H.v.A., L.H.V.), Elisabeth-Tweesteden Hospital, Tilburg; Department of Neurology and Neurosurgery (J.A.T., I.J.T.H., H.S.G., W.L.v.d.P., L.H.v.d.B.), Brain Center Rudolf Magnus, UMC Utrecht; Department of Neurology and Clinical Neurophysiology (C.V.), Academic Medical Center, Amsterdam; and Department of Biostatistics (S.N.), Julius Center for Health Sciences and Primary Care, UMC Utrecht, the Netherlands
| | - Leonard H van den Berg
- From the Department of Neurology and Clinical Neurophysiology (J.A.T., I.J.T.H., J.-T.H.v.A., L.H.V.), Elisabeth-Tweesteden Hospital, Tilburg; Department of Neurology and Neurosurgery (J.A.T., I.J.T.H., H.S.G., W.L.v.d.P., L.H.v.d.B.), Brain Center Rudolf Magnus, UMC Utrecht; Department of Neurology and Clinical Neurophysiology (C.V.), Academic Medical Center, Amsterdam; and Department of Biostatistics (S.N.), Julius Center for Health Sciences and Primary Care, UMC Utrecht, the Netherlands
| | - Leo H Visser
- From the Department of Neurology and Clinical Neurophysiology (J.A.T., I.J.T.H., J.-T.H.v.A., L.H.V.), Elisabeth-Tweesteden Hospital, Tilburg; Department of Neurology and Neurosurgery (J.A.T., I.J.T.H., H.S.G., W.L.v.d.P., L.H.v.d.B.), Brain Center Rudolf Magnus, UMC Utrecht; Department of Neurology and Clinical Neurophysiology (C.V.), Academic Medical Center, Amsterdam; and Department of Biostatistics (S.N.), Julius Center for Health Sciences and Primary Care, UMC Utrecht, the Netherlands.
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Takeuchi M, Wakao N, Kamiya M, Hirasawa A, Murotani K, Takayasu M. Simple presurgical method of predicting C5 palsy after cervical laminoplasty using C5 nerve root ultrasonography. J Neurosurg Spine 2018; 29:365-370. [DOI: 10.3171/2018.2.spine171363] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVEThe incidence of C5 palsy after cervical laminoplasty is approximately 5%. Because C5 palsy is related to cervical foraminal stenosis at the C4–5 level, the authors hypothesized that cervical foraminal stenosis can be diagnosed by examining the C5 nerve root (NR) using ultrasonography. The purpose of this study was to investigate whether postoperative C5 palsy could be predicted using ultrasonography.METHODSThis study used a prospective diagnosis design. In total, 140 patients undergoing cervical laminoplasty were examined with ultrasound. The cross-sectional area (CSA) of the C5 NR was measured on both sides before surgery, and the incidence of postoperative C5 palsy was examined. The difference between the CSA of the patients with and without C5 palsy and the lateral differences in the C5 palsy group were determined.RESULTSThe incidence of C5 palsy was 5% (7 cases). Symptoms manifested at a median of 5 days after surgery (range 1–29 days). The CSA of the C5 NR on the affected side was significantly enlarged in the C5 palsy group compared with that in the no–C5 palsy group (p = 0.001). In addition, in the patients who had C5 palsy, the CSA of the C5 NR was significantly enlarged on the affected side compared with that on the unaffected side (p = 0.02). Receiver operating characteristic analysis indicated that the best threshold value for the CSA of the C5 NR was 10.4 mm2, which provided 91% sensitivity and 71% specificity.CONCLUSIONSC5 palsy may be predicted preoperatively using ultrasound. The authors recommend the ultrasonographic measurement of the CSA of the C5 NR prior to cervical laminoplasty.
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Affiliation(s)
- Mikinobu Takeuchi
- 1Spine Center,
- 2Department of Neurological Surgery,
- 5Department of Spine Surgery, Aichi Spine Hospital, Inuyama, Aichi, Japan
| | | | | | | | - Kenta Murotani
- 4Biostatistics and Clinical Research Center, Aichi Medical University Hospital, Nagakute, Aichi, Japan, and
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Walker FO, Cartwright MS, Alter KE, Visser LH, Hobson-Webb LD, Padua L, Strakowski JA, Preston DC, Boon AJ, Axer H, van Alfen N, Tawfik EA, Wilder-Smith E, Yoon JS, Kim BJ, Breiner A, Bland JDP, Grimm A, Zaidman CM. Indications for neuromuscular ultrasound: Expert opinion and review of the literature. Clin Neurophysiol 2018; 129:2658-2679. [PMID: 30309740 DOI: 10.1016/j.clinph.2018.09.013] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Revised: 08/10/2018] [Accepted: 09/02/2018] [Indexed: 12/11/2022]
Abstract
Over the last two decades, dozens of applications have emerged for ultrasonography in neuromuscular disorders. We wanted to measure its impact on practice in laboratories where the technique is in frequent use. After identifying experts in neuromuscular ultrasound and electrodiagnosis, we assessed their use of ultrasonography for different indications and their expectations for its future evolution. We then identified the earliest papers to provide convincing evidence of the utility of ultrasound for particular indications and analyzed the relationship of their date of publication with expert usage. We found that experts use ultrasonography often for inflammatory, hereditary, traumatic, compressive and neoplastic neuropathies, and somewhat less often for neuronopathies and myopathies. Usage significantly correlated with the timing of key publications in the field. We review these findings and the extensive evidence supporting the value of neuromuscular ultrasound. Advancement of the field of clinical neurophysiology depends on widespread translation of these findings.
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Affiliation(s)
- Francis O Walker
- Department of Neurology at Wake Forest School of Medicine, Medical Center Blvd, Winston-Salem, NC, USA.
| | - Michael S Cartwright
- Department of Neurology at Wake Forest School of Medicine, Medical Center Blvd, Winston-Salem, NC, USA.
| | - Katharine E Alter
- Department of Rehabilitation Medicine, National INeurolnstitutes of Health, Bethesda, MD 20892, USA.
| | - Leo H Visser
- Departments of Neurology and Clinical Neurophysiology, Elisabeth-Tweesteden Hospital, Tilburg, The Netherlands.
| | - Lisa D Hobson-Webb
- Department of Neurology, Neuromuscular Division, Duke University School of Medicine, Durham, NC, USA.
| | - Luca Padua
- Don Carlo Gnocchi ONLUS Foundation, Piazzale Rodolfo Morandi, 6, 20121 Milan, Italy; Department of Geriatrics, Neurosciences and Orthopaedics, Universita Cattolica del Sacro Cuore, Rome, Italy.
| | - Jeffery A Strakowski
- Department of Physical Medicine and Rehabilitation, The Ohio State University, Columbus, OH, USA; Department of Physical Medicine and Rehabilitation, OhioHealth Riverside Methodist Hospital, Columbus, OH, USA; OhioHealth McConnell Spine, Sport and Joint Center, Columbus, OH, USA.
| | - David C Preston
- Neurological Institute, University Hospitals, Cleveland Medical Center, Case Western Reserve University, Cleveland, OH, USA.
| | - Andrea J Boon
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN, USA.
| | - Hubertus Axer
- Hans Berger Department of Neurology, Jena University Hospital, Jena 07747, Germany.
| | - Nens van Alfen
- Department of Neurology and Clinical Neurophysiology, Donders Institute for Brain, Cognition, and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands.
| | - Eman A Tawfik
- Department of Physical Medicine & Rehabilitation, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
| | - Einar Wilder-Smith
- Department of Neurology, Yong Loo Lin School of Medicine, National University Singapore, Singapore; Department of Neurology, Kantonsspital Lucerne, Switzerland; Department of Neurology, Inselspital Berne, Switzerland.
| | - Joon Shik Yoon
- Department of Physical Medicine and Rehabilitation, Korea University Guro Hospital, Seoul, Republic of Korea.
| | - Byung-Jo Kim
- Department of Neurology, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea.
| | - Ari Breiner
- Division of Neurology, Department of Medicine, The Ottawa Hospital and University of Ottawa, Canada.
| | - Jeremy D P Bland
- Deparment of Clinical Neurophysiology, East Kent Hospitals University NHS Foundation Trust, Canterbury, Kent, UK.
| | - Alexander Grimm
- Department of Neurology, University Hospital Tuebingen, Tuebingen, Germany.
| | - Craig M Zaidman
- Division of Neuromuscular Medicine, Department of Neurology, Washington University in St. Louis, 660 S. Euclid Ave, Box 8111, St. Louis, MO 63110, USA.
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Investigation of the Effect of Cervical Radiculopathy on Peripheral Nerves of the Upper Extremity With High-Resolution Ultrasonography. Spine (Phila Pa 1976) 2018; 43:E798-E803. [PMID: 29293163 DOI: 10.1097/brs.0000000000002539] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Prospective, cross-sectional observational study. OBJECTIVE We aimed to investigate the effects of chronic cervical radiculopathy (CR) on the cross-sectional area (CSA) values of the cervical nerve roots (CNRs), median, ulnar, and radial nerves with high-resolution ultrasonography. SUMMARY OF BACKGROUND DATA Symptomatic nerve roots are wider than asymptomatic nerve roots due to the presence of edema. Peripheral nerves have also been shown to develop edema, fibrosis, and changes distal to the affected nerve as a result of mechanical compression. In addition according to "double-crush syndrome" hypothesis, the peripheral nerves are more sensitive to pressure, and a proximal nerve lesion makes the distal segment of the nerve more susceptible to anatomic deterioration by causing interruption in the axoplasmic conduction due to compression. METHODS Forty patients with chronic CR were included to the study. Both affected CNRs and the contralateral nerve roots (control group) were evaluated with high-resolution ultrasonography. Ulnar and median nerve CSA measurements were performed at four measurement points and radial nerve measurements at a single measurement point. RESULTS CSA measurements were statistically significantly higher at the CNR of the affected side compared to the unaffected side. There was no statistically significant difference when affected and unaffected sides were compared in terms of measurements performed from median, ulnar, and radial nerves at all measurement points. CONCLUSION The results of the present study indicate that the changes in the CNR caused by CR do not have any effect on the peripheral nerves. We did not find any affection in peripheral nerve CSA that might have been suggestive of double-crush syndrome in CR. LEVEL OF EVIDENCE 2.
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15
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Investigation of the effectiveness of therapeutic ultrasound with high-resolution ultrasonographic cross-sectional area measurement of cervical nerve roots in patients with chronic cervical radiculopathy: a prospective, controlled, single-blind study. J Med Ultrason (2001) 2018; 45:479-486. [DOI: 10.1007/s10396-017-0855-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Accepted: 12/06/2017] [Indexed: 10/18/2022]
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