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Rayegani SM, Bahrami MH, Aalipour K, Malek Mahmoudi R, Maleki Kahaki S. Optimization of Muscle Selection for Needle Electromyography in Isolated C6 Root Lesion: A Prospective Chart Review Study. Am J Phys Med Rehabil 2024; 103:439-443. [PMID: 38063323 DOI: 10.1097/phm.0000000000002369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/20/2024]
Abstract
OBJECTIVES The aim of the study is to evaluate muscles with more prominent needle electromyographic findings to optimize needle electromyography screening of isolated C6 radiculopathy in patients with C6 root lesions. DESIGN This prospective clinical study was performed on 39 patients with isolated and unilateral cervical radiculopathy selected from all referrals of 1733 patients to the electrodiagnosis unit of the physical medicine and rehabilitation department of a tertiary medical center (from April 2021 to December 2021). The presence of fibrillation potentials, positive sharp waves, and/or neurogenic motor action potentials that occurred in isolation or combination with selected muscles was considered an abnormal finding. RESULTS Of 1733 referrals, 39 patients (18 males [46.1%] and 21 females [53.8%]), with a mean age of 49.7 ± 9.6 yrs, were found eligible. According to needle electromyography findings, the most involved muscles in C6 root lesion were pronator teres (100%), followed by extensor carpi radialis longus (94.8%), flexor carpi radialis (89.7%), brachioradialis (82%), infraspinatus (82%), supraspinatus (79.4%), deltoid (74.3%), biceps brachii (64.1%), extensor digitorum communis (33.3%), and triceps brachii (15.3%) muscles. CONCLUSIONS The pronator teres is the most involved muscle of patients diagnosed with C6 radiculopathy. It might be considered the key muscle for screening and accurate diagnosis of C6 root involvement.
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Affiliation(s)
- Seyed Mansoor Rayegani
- From the Physical Medicine and Rehabilitation Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Levaro F, Hill EJR, Bertelli JA. A cut throat: a case of C5-C8 brachial plexus root transection providing evidence of T1 innervation of thumb and finger extensors. Br J Neurosurg 2024; 38:128-130. [PMID: 36062588 DOI: 10.1080/02688697.2022.2118233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 08/23/2022] [Indexed: 11/02/2022]
Abstract
The T1 nerve root is not routinely thought of as innervating the extensors of the thumb and fingers. Work by Bertelli and Ghizoni proposed that the pattern of brachial plexus paralysis with intact hand function and thumb and finger extensors traditionally attributed to C5/6/7 root injury is in fact a C5/6/7/8 injury, with only T1 remaining intact - a 'T1 hand'. This case presents a 19-year-old male who was stabbed in the neck; exploratory surgery determined complete transection of the brachial plexus, with only the T1 nerve root remaining intact. Clinical examination demonstrated grade M4 pronation (with pronator quadratus), wrist extension (with extensor carpi ulnaris), thumb and finger extension (with extensor policis longus and brevis, extensor digitorum communis and extensor index proprius), wrist flexion (with palmaris longus), finger flexion (with flexor digitorum superficialis and profundus), thumb flexion (with flexor policis longus), and thenar and hypothenar muscles. Extensor carpi radialis longus and brevis, flexor carpi radialis and flexor carpi ulnaris were paralyzed. Triceps scored M2. This case provides unequivocal evidence that the T1 root provides significant innervation to the extrinsic thumb and finger extensors.
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Affiliation(s)
- Fernando Levaro
- Department of Orthopaedic Surgery, The University of Texas, Houston, TX, USA
| | - Elspeth Jane Rose Hill
- Department of Orthopaedic Surgery, Governador Celso Ramos Hospital, Florianópolis, Brazil
- Department of Medicine and Surgery, Harris Manchester College, Oxford University, Oxford, England
| | - Jayme Augusto Bertelli
- Department of Orthopaedic Surgery, Governador Celso Ramos Hospital, Florianópolis, Brazil
- Center of Biological and Health Sciences, Department of Neurosurgery, University of the South of Santa Catarina (Unisul), Tubarão, Brazil
- Department of Plastic Surgery, Joana de Gusmão Children's Hospital, Florianópolis, Brazil
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Sonoo M. Recent advances in neuroanatomy: the myotome update. J Neurol Neurosurg Psychiatry 2023; 94:643-648. [PMID: 36653172 DOI: 10.1136/jnnp-2022-329696] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 01/10/2023] [Indexed: 01/20/2023]
Abstract
The myotome of a muscle is the basis for diagnosing spinal and peripheral nerve disorders. Despite its critical importance in clinical neurology, myotome charts presented in many textbooks, surprisingly, show non-negligible discordances with each other. Many authors do not even clearly state the bases of their charts. Studies that have presented with raw data regarding myotome identification are rather rare. A classic study in the 19th century that pursued the nerve course in cadavers still has a substantial influence on existing charts, despite its definite limitations. Other scarce studies in humans include identification by root stimulation during surgery, clinical observations in root avulsion or spinal cord injury and clinical and electromyographical investigations in patients with single radiculopathies or certain plexopathies. A few recent studies have proposed new theories regarding the myotomes of some muscles. T1 innervation of the median intrinsic hand muscles is a typical example. We have added a number of new findings, such as T1 innervation of the forearm flexor muscles innervated by the median nerve except the pronator teres and flexor carpi radialis, C5 innervation of the brachioradialis, and two C6 indicator muscles, pronator teres and extensor carpi radialis brevis. Increased accuracy of the myotome charts will improve the localisation in neurology.
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Affiliation(s)
- Masahiro Sonoo
- Department of Neurology, Teikyo University School of Medicine, Itabashi-ku, Tokyo, Japan
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Jawad ZY, Hamdan FB, Nema IS. Neurophysiologic evaluation of patients with cervical spondylotic myelopathy. THE EGYPTIAN JOURNAL OF NEUROLOGY, PSYCHIATRY AND NEUROSURGERY 2022. [DOI: 10.1186/s41983-022-00595-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Abstract
Background
Cervical spondylotic myelopathy (CSM) is a neurodegenerative disease caused by repetitive spinal cord damage that has resulted in significant clinical morbidity. The clinical evaluation of signs and symptoms, as well as neuroimaging and several neurophysiological tests, are used to make the diagnosis.
Objectives
To investigate changes in the cutaneous silent period (CuSP), cortical silent period (CoSP), and H-reflex in CSM patients, and to correlate these tests with the Japanese Orthopedic Association (JOA) score and Nurick’s grading, as well as to determine the diagnostic value of each of them.
Methods
Twenty patients (14 males and 6 females) with CSM were clinically diagnosed and documented by magnetic resonance imaging (MRI), and they were paired with another 20 healthy volunteers (13 males and 7 females) as a control group. CuSP, CoSP, and H-reflex tests were performed on both groups.
Results
In CSM patients, CuSP latency and duration are substantially longer and shorter in CSM patients, respectively. The degree of changes in CuSP latency is well correlated with the severity of the disease. Further, CoSP duration is significantly shortened. The H-reflex parameters did not differ significantly between the patient and control groups.
Conclusion
The shortened CoSP’s duration and the prolonged CuSP's latency suggest malfunction of the inhibitory and excitatory circuits in the spinal cord. The CuSP is more sensitive and specific than the CoSP in the diagnosis of a patient with CSM.
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Nyman E, Giöstad A, Abul-Kasim K, Dahlin L. Patients having surgery for ulnar nerve compression at the elbow rarely have affection of the spinal nerve root at C8-Th1 levels. Front Surg 2022; 9:1049081. [PMID: 36578969 PMCID: PMC9790900 DOI: 10.3389/fsurg.2022.1049081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 11/16/2022] [Indexed: 12/14/2022] Open
Abstract
Cervical pathology may contribute to residual problems after surgery for ulnar nerve compression. We aimed to evaluate the presence of pathological conditions in spinal cord and cervical spinal nerve roots in patients surgically treated for ulnar nerve compression at elbow. In a cohort of patients, surgically treated for ulnar nerve compression at elbow, magnetic resonance images (MRI; performed 3 years pre/postoperatively) were evaluated by a neuroradiologist blinded to patient characteristics and outcome of surgery. Cervical conditions were assessed and related to patient characteristics, preoperative McGowan grade, and outcome. Among 62 patients (45 unilaterally and 17 bilaterally), only one had spinal nerve root affection of nerve roots contributing to the ulnar nerve (C8-Th1). About half of the patients, mainly those at higher age, had alterations affecting C3-C7 spinal nerve roots at both surgically treated and contralateral, non-surgically treated, sides. Only few other changes were observed at cervical levels. A high McGowan grading was related to a high frequency of spinal nerve root affection. Smokers were more frequently observed among those with spinal nerve root affection at C3-C7 levels at surgically treated side. Residual problems, expressed as patient dissatisfaction and DASH score ≥40, were common. Spinal nerve roots, contributing to the ulnar nerve, are rarely affected in surgically treated patients with ulnar nerve compression at elbow even though pathology is often observed at other cervical levels. Pathology is often detected at other cervical spinal nerve root levels at surgically treated and contralateral sides, particularly among older patients, smokers, and in conjunction with worse preoperative McGowan grade. No relation between cervical pathology and outcome of ulnar nerve surgery is seen.
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Affiliation(s)
- Erika Nyman
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden,Department of Hand Surgery, Plastic Surgery and Burns, Linköping University Hospital, Linköping, Sweden
| | - Alice Giöstad
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden,Primary Health Care Center Kolmården, Kolmården, Sweden
| | - Kasim Abul-Kasim
- Department of Radiology, Skåne University Hospital, Malmö, Sweden
| | - Lars B. Dahlin
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden,Department of Hand Surgery, Skåne University Hospital, Malmö, Sweden,Department of Translational Medicine – Hand Surgery, Lund University, Malmö, Sweden,Correspondence: Lars B. Dahlin
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Tadokoro N, Hashimoto K, Kiyasu K, Kasai Y, Aoyama N, Takemasa R, Ikeuchi M. Finger trembling improvement after surgery in Hirayama disease: a case report. Spinal Cord Ser Cases 2022; 8:44. [PMID: 35468891 PMCID: PMC9038729 DOI: 10.1038/s41394-022-00514-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 04/09/2022] [Accepted: 04/13/2022] [Indexed: 11/09/2022] Open
Abstract
INTRODUCTION Finger trembling is a characteristic physical finding in Hirayama disease. Although conservative treatment is recommended to stop disease progression, surgery is optional in some cases. However, the postoperative recovery of finger trembling is scarcely reported. CASE PRESENTATION A 26-year-old Japanese female patient whose chief complaint was left finger trembling with active finger extension presented at our hospital. Hand weakness without muscle atrophy of the left arm was observed. MRI showed left-side oriented intramedullary signal change with concomitant cord atrophy at C4-5 and C5-6. The CT myelogram (CTM) on flexion showed anterior cord compression and anterior shift of posterior dura matter from C4 to C6. And CTM on extension showed the resolution of both findings. Electrophysiological studies showed active and chronic neuronal damage and preserved motor neuron pool of hand muscle. Since she had exhibited a gradual aggravation of symptoms over a period of 5 years, she underwent anterior cervical discectomy and fusion after careful assessment of both conservative and surgical treatment. Finger trembling recovered soon after surgery. DISCUSSION Finger trembling is an unfamiliar physical finding in terms of postoperative recovery prediction. Anterior horn cell impairment is postulated as a cause of finger trembling. Postural restoration of spinal cord shape and cerebrospinal fluid around the cord with preserved neural function could facilitate functional recovery.
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Imajo Y, Kanchiku T, Suzuki H, Nishida N, Funaba M, Taguchi T, Sakai T. Assessment of spinal cord relative vulnerability in C4-C5 compressive cervical myelopathy using multi-modal spinal cord evoked potentials and neurological findings. J Spinal Cord Med 2021; 44:541-548. [PMID: 31180810 PMCID: PMC8288130 DOI: 10.1080/10790268.2019.1617920] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
Objective: The correlation between the progression of spinal cord lesions using spinal cord evoked potentials (SCEPs) and neurological findings are unclear. The purpose is to electrophysiologically evaluate relative vulnerability of spinal cord in patients with compressive cervical myelopathy (CCM) at C4-C5 intervertebral level using SCEPs and correlate the progression of spinal cord lesions with neurological findings.Design: Retrospective study.Setting: Yamaguchi University Hospital.Participants: 36 patients.Methods: SCEPs following median nerve stimulation (MN-SCEPs), ulnar nerve stimulation (UN-SCEPs), transcranial electric stimulation (TCE-SCEPs), and spinal cord stimulation (SC-SCEPs) were intraoperatively recorded. MN-SCEPs are mediated by posterior horns (4, 5 layers), UN-SCEPs by the Burdach tract, TCE-SCEPs by the lateral corticospinal tract, and SC-SCEPs by the Goll tract. We evaluated the neurological findings (numbness, tactile sense and pain sense in the C6 area, tactile sense in the lower extremities, and triceps tendon reflex [TTR]).Results: The incidence of electrophysiological and clinical abnormalities decreased in the order of UN-SCEPs (100%), TCE-SCEPs (94.4%), MN-SCEPs (77.8%), and SC-SCEPs (69.4%), and in the order of numbness (100%), pain sense (97.2%), TTR (91.7%), tactile sense in the C6 area (83.3%), and tactile sense in the lower extremities (70.0%), respectively.Conclusions: The relative vulnerability of spinal cord occurred in the order of the Burdach tract, the lateral corticospinal tract, posterior horns (4, 5 layers), and the Goll tract in most patients with CCM at the C4-C5 intervertebral level.
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Affiliation(s)
- Yasuaki Imajo
- Department of Orthopedic Surgery, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan,Correspondence to: Yasuaki Imajo, 1-1 Minami-kogushi, Ube, Yamaguchi755-8505, Japan.
| | - Tsukasa Kanchiku
- Department of Orthopedic Surgery, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan
| | - Hidenori Suzuki
- Department of Orthopedic Surgery, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan
| | - Norihiro Nishida
- Department of Orthopedic Surgery, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan
| | - Masahiro Funaba
- Department of Orthopedic Surgery, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan
| | - Toshihiko Taguchi
- Department of Orthopedic Surgery, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan
| | - Takashi Sakai
- Department of Orthopedic Surgery, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan
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Kim SW, Sung DH. Case Report: Neurogenic Thoracic Outlet Syndrome Without Electrophysiologic Abnormality. Front Neurol 2021; 12:644893. [PMID: 33897600 PMCID: PMC8062872 DOI: 10.3389/fneur.2021.644893] [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: 12/22/2020] [Accepted: 03/17/2021] [Indexed: 11/13/2022] Open
Abstract
Neurogenic thoracic outlet syndrome (N-TOS) is a chronic compressive brachial plexopathy that involves the C8, T1 roots, and/or lower trunk. Medial antebrachial cutaneous (MABC) nerve conduction study (NCS) abnormality is reportedly one of the most sensitive findings among the features of N-TOS. The aim of the present study was to report clinical features, imaging findings, treatment, and prognoses of two N-TOS patients with no abnormalities in electrophysiological studies. Both patients presented with paresthesia of unilateral arm, and examination revealed no neurologic deficits. Electrophysiologic studies including MABC NCS were normal. Computed tomography (CT) angiography and brachial plexus magnetic resonance imaging (MRI) of the patients showed compression and displacement of the neurovascular bundle in the thoracic outlet by causative structures. Due to their sensory symptoms and CT angiography and brachial plexus MRI findings, after excluding other diseases, we diagnosed them with N-TOS. With the development of imaging techniques, more patients presenting with clinical features of lower trunk brachial plexopathy and anomalous structures compressing the neurovascular bundle on imaging studies can be diagnosed with N-TOS, even if electrophysiologic studies including MABC NCS do not show abnormalities.
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Affiliation(s)
- Sun Woong Kim
- Department of Physical and Rehabilitation Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Duk Hyun Sung
- Department of Physical and Rehabilitation Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
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Mendonça RH, Machado LMS, Heise CO, Polido GJ, Matsui C, Silva AMS, Reed UC, Zanoteli E. Motor unit number index (MUNIX) in children and adults with 5q-spinal muscular atrophy: Variability and clinical correlations. Neuromuscul Disord 2021; 31:498-504. [PMID: 33824074 DOI: 10.1016/j.nmd.2021.02.019] [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: 08/05/2020] [Revised: 02/11/2021] [Accepted: 02/24/2021] [Indexed: 11/25/2022]
Abstract
Spinal muscular atrophy (SMA) is a motor neuron disease associated with progressive muscle weakness and motor disability. The motor unit number index (MUNIX) is a biomarker used to assess loss of motor units in later-onset SMA patients. Twenty SMA patients (SMA types 3 and 4), aged between 7 and 41 years, were clinically evaluated through the Hammersmith Motor Functional Scale Expanded and the Spinal Muscular Atrophy-Functional Rating Scale. The patients underwent compound motor action potential (CMAP) and MUNIX studies of the right abductor pollicis brevis, abductor digiti minimi and tibialis anterior (TA) muscles. Age-matched healthy controls (n = 20) were enrolled to obtain normative CMAP and MUNIX values from the same muscles. Compared to healthy controls, SMA patients showed significant reductions in MUNIX values among all muscles studied, whereas CMAP showed reductions only in the weaker muscles (abductor digiti minimi and TA). MUNIX variability was significantly higher in the SMA group than in the control group. MUNIX variability in TA correlated with CMAP variability. Motor functional scores correlated with TA MUNIX. The MUNIX study is feasible in later-onset SMA patients, and TA MUNIX values correlate with disease severity in patients with mild motor impairment.
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Affiliation(s)
| | | | - Carlos Otto Heise
- Department of Neurology, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Graziela Jorge Polido
- Department of Neurology, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Ciro Matsui
- Department of Neurology, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | | | - Umbertina Conti Reed
- Department of Neurology, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Edmar Zanoteli
- Department of Neurology, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.
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Furukawa Y, Miyaji Y, Kadoya A, Kamiya H, Chiba T, Hokkoku KI, Hatanaka Y, Imafuku I, Miyoshi K, Sonoo M. Determining C5, C6 and C7 myotomes through comparative analyses of clinical, MRI and EMG findings in cervical radiculopathy. Clin Neurophysiol Pract 2021; 6:88-92. [PMID: 33748550 PMCID: PMC7966958 DOI: 10.1016/j.cnp.2021.02.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Revised: 01/02/2021] [Accepted: 02/08/2021] [Indexed: 11/18/2022] Open
Abstract
Objective There are many myotome charts in the literature, but few studies have presented actual data to support their identification. We aimed to determine C5/C6/C7 myotomes based on clinical and EMG data of patients with cervical spondylotic radiculopathy (CSR) having a single-root lesion confirmed by MRI. Methods Medical Research Council (MRC) scores and EMG findings were retrospectively reviewed for patients enrolled from our EMG database. Results Enrolled were 25 patients (10 C5, 6 C6, and 9 C7 CSR). In C5 CSR, weakness or denervation potentials in EMG, or both, were observed in the deltoid (Del) and infraspinatus (Isp) muscles for all patients, and in the biceps brachii (BB) and brachioradialis (BR) muscles for 9/10 and 8/9 patients, respectively. In C6 CSR, weakness of the wrist extensor and/or denervation of the extensor carpi radialis longus (ECRL)/extensor carpi radialis brevis (ECRB), and those of the pronator teres (PT) were observed for all patients. Weakness was not observed for any other muscle in C6 CSR. Denervation potentials of ECRL were found in 5/8 and 3/5 patients with C5 and C6 CSR, respectively, whereas those of ECRB were found in 1/5, 6/6, and 2/5 patients with C5, C6 and C7 CSR, respectively. In C7 CSR, weakness/denervation of the triceps brachii (TB) and denervation potentials of the flexor carpi radialis (FCR) were observed for all patients. Denervation potentials in PT and weakness/denervation of the extensor digitorum (ED) were observed in 2/9 and 4/9 patients, respectively. Conclusion Suggested dominant myotomes are: C5 for the Del, Isp, BB, and BR, C5/6 for the ECRL, C6 > C7 for the ECRB and PT, and C7 for the TB and FCR. Significance The current study identified dominant myotomes that differ from the existing literature.
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Affiliation(s)
- Yuichi Furukawa
- Department of Neurology, Teikyo University School of Medicine, Kaga 2-11-1, Itabashi-ku, Tokyo, Japan
| | - Yosuke Miyaji
- Department of Neurology, Teikyo University School of Medicine, Kaga 2-11-1, Itabashi-ku, Tokyo, Japan
- Department of Neurology and Stroke Medicine, Yokohama City University Graduate School of Medicine, Fukuura 3-9, Kanazawa-ku, Yokohama-shi, Kanagawa, Japan
| | - Akiko Kadoya
- Department of Neurology, Anti-aging and Vascular Medicine, National Defense Medical College, Namiki 3-2, Tokorozawa-shi, Saitama, Japan
| | - Hisao Kamiya
- Department of Neurology, Teikyo University School of Medicine, Kaga 2-11-1, Itabashi-ku, Tokyo, Japan
| | - Takashi Chiba
- Department of Neurology, Teikyo University School of Medicine, Kaga 2-11-1, Itabashi-ku, Tokyo, Japan
| | - Kei-ichi Hokkoku
- Department of Neurology, Teikyo University School of Medicine, Kaga 2-11-1, Itabashi-ku, Tokyo, Japan
| | - Yuki Hatanaka
- Department of Neurology, Teikyo University School of Medicine, Kaga 2-11-1, Itabashi-ku, Tokyo, Japan
| | - Ichiro Imafuku
- Department of Neurology, Yokohama Rosai Hospital, Kozukue 3211, Kohoku-ku, Yokohaya-shi, Kanagawa, Japan
| | - Kota Miyoshi
- Department of Orthopedics, Yokohama Rosai Hospital, Kozukue 3211, Kohoku-ku, Yokohaya-shi, Kanagawa, Japan
| | - Masahiro Sonoo
- Department of Neurology, Teikyo University School of Medicine, Kaga 2-11-1, Itabashi-ku, Tokyo, Japan
- Corresponding author.
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Zheng C, Zhu Y, Shao M, Zhu D, Hu H, Qiao K, Jiang J. Split-hand phenomenon quantified by the motor unit number index for distinguishing cervical spondylotic amyotrophy from amyotrophic lateral sclerosis. Neurophysiol Clin 2019; 49:391-404. [DOI: 10.1016/j.neucli.2019.09.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2019] [Revised: 09/24/2019] [Accepted: 09/24/2019] [Indexed: 12/13/2022] Open
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Kim SW, Jeong JS, Kim BJ, Choe YH, Yoon YC, Sung DH. Clinical, electrodiagnostic and imaging features of true neurogenic thoracic outlet syndrome: Experience at a tertiary referral center. J Neurol Sci 2019; 404:115-123. [PMID: 31374409 DOI: 10.1016/j.jns.2019.07.024] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Revised: 07/16/2019] [Accepted: 07/18/2019] [Indexed: 11/19/2022]
Abstract
OBJECTIVE True neurogenic thoracic outlet syndrome (TN-TOS) is an extremely rare neuromuscular disease. We report clinical, electrodiagnostic and radiologic features of patients with TN-TOS. METHODS Retrospective chart review of patients satisfying criteria was done. Nerve conduction study (NCS) and needle electromyography (EMG) of upper extremity were reviewed. Brachial plexus MRI and computed tomography angiography (CTA) were also reviewed. RESULTS Thirteen TN-TOS patients were identified. The most common neurologic signs were hypesthesia in the medial forearm or ulnar digits and weakness of the abductor pollicis brevis (APB) muscle. In NCS, medial antebrachial cutaneous (MABC) sensory nerve action potential amplitude was decreased in all tested patients. The APB muscle was most commonly involved in EMG. Among radiologic criteria, focal stenosis of subclavian artery in CTA was the most common finding. CONCLUSION We confirmed that TN-TOS is T1 predominant lower roots/trunk brachial plexopathy with clinical and electrodiagnostic features. Radiologic studies may be used to detect structural abnormalities. SIGNIFICANCE As MABC NCS showed abnormal results in all tested patients, it should be added to electrodiagnostic study as screening method. If present, structural abnormalities might be confirmed with radiologic studies.
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Affiliation(s)
- Sun Woong Kim
- Department of Physical and Rehabilitation Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Ji Seon Jeong
- Department of Physical and Rehabilitation Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Byoung Joon Kim
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Yeon Hyeon Choe
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Young Cheol Yoon
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Duk Hyun Sung
- Department of Physical and Rehabilitation Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
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Discrepancy between functional recovery and cutaneous silent period change in surgically treated degenerative cervical myelopathy: a prospective pilot study. Spinal Cord 2019; 57:1076-1083. [DOI: 10.1038/s41393-019-0314-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2019] [Revised: 06/03/2019] [Accepted: 06/04/2019] [Indexed: 02/05/2023]
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Imajo Y, Kanchiku T, Suzuki H, Funaba M, Nishida N, Taguchi T. Utility of the central motor conduction time recorded from the abductor pollicis brevis and the abductor digiti minimi muscles in patients with C6-7 myelopathy. J Spinal Cord Med 2018; 41:182-191. [PMID: 28514903 PMCID: PMC5901454 DOI: 10.1080/10790268.2017.1322673] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
OBJECTIVE Central motor conduction time (CMCT) recorded from the abductor pollicis brevis (CMCT-APB) and abductor digiti minimi (CMCT-ADM) muscles may enable the evaluation of patients with C6-7 myelopathy. CMCT is more useful for the evaluation of the function of spinal cord than magnetic resonance imaging (MRI) findings. CMCT may be associated with age and height. However, there are few reports regarding CMCT-APB in normal subjects. This study aimed to investigate the relationships between age, height, and conduction parameters in normal subjects to assess the effectiveness of using CMCT-APB and CMCT-ADM for the evaluation of patients with C6-7 and C7-T1 myelopathy. DESIGN Retrospective study. METHODS Fifteen patients with cervical compressive myelopathy at C6-7 (11 patients) or C7-T1 (4 patients) level were enrolled. The control group consisted of 150 normal subjects (mean age 45.8±17.0 years; mean height 163.6±8.9 cm). Motor evoked potentials induced by transcranial magnetic stimulation and F-waves were used to determine CMCT. OUTCOME MEASURES CMCT-APB, CMCT-ADM. RESULTS The normative values of CMCT-APB and CMCT-ADM were 5.3±0.7 ms and 5.2±0.8 ms, respectively. CMCT-APB was significantly longer than CMCT-ADM for patients with C6-7 myelopathy (P < 0.05). Neither of the CMCTs for those with C7-T1 myelopathy were significantly different from those of controls, but CMCT-APB was more prolonged than CMCT-ADM in patients with C6-C7 myelopathy. CONCLUSIONS CMCTs improve the accuracy of the diagnosis of myelopathy by pinpointing the lesion in combination with MRI imaging. Selective CMCT-APB prolongation may be seen in patients with C6-7 myelopathy but not C7-T1 myelopathy.
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Affiliation(s)
- Yasuaki Imajo
- Correspondence to: Yasuaki Imajo, MD, 1-1 Minami-kogushi, Ube, Yamaguchi, 755-8505, Japan.
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Sadeh M, Dabby R. Apparent C8-T1 radiculopathy with hand weakness due to mid-cervical spondylosis. J Clin Neurosci 2018; 47:111-115. [DOI: 10.1016/j.jocn.2017.10.071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Accepted: 10/23/2017] [Indexed: 10/18/2022]
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Amyotrophic lateral sclerosis with a sudden-onset history. Clin Neurophysiol Pract 2017; 2:103-104. [PMID: 30214980 PMCID: PMC6123847 DOI: 10.1016/j.cnp.2017.04.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2017] [Revised: 04/18/2017] [Accepted: 04/23/2017] [Indexed: 11/21/2022] Open
Abstract
We reported on two patients with ALS with a sudden-onset history. Marked weakness of the extensor digitorum with relatively mild weakness of the other muscles was characteristic. The risk of initial misdiagnosis is high for such patients.
Objective We report on two patients with amyotrophic lateral sclerosis (ALS) complaining of sudden-onset difficulty in finger elevation. Case report A 65-year-old man (the first patient) and a 66-year-old man (the second patient) suddenly became aware of difficulty in finger elevation of one hand. They were not aware of any other symptoms prior to the onset. In the first patient, cerebral infarction at the precentral gyrus was initially suspected. In the second patient, cervical spondylosis was initially suspected, and cervical spine surgery was planned. However, needle EMG revealed widespread neurogenic changes and abundant fasciculation potentials for both patients. Widespread weakness emerged in time and relentlessly progressed, and finally the diagnosis of ALS was made. In both cases, notable weakness in the extensor digitorum (ED) muscle with relatively mild weakness in the other muscles in the affected limb was a characteristic finding. Loss of one motor unit in ED that has already enlarged due to reinnervation must have caused sudden awareness of the weakness. Significance Clinicians should recognize the presence of ALS patients with a sudden-onset history because the risk of initial misdiagnosis is high for such patients.
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Fang J, Liu MS, Guan YZ, Du H, Li BH, Cui B, Ding QY, Cui LY. Pattern Differences of Small Hand Muscle Atrophy in Amyotrophic Lateral Sclerosis and Mimic Disorders. Chin Med J (Engl) 2017; 129:792-8. [PMID: 26996473 PMCID: PMC4819298 DOI: 10.4103/0366-6999.178953] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Background: Amyotrophic lateral sclerosis (ALS) and some mimic disorders, such as distal-type cervical spondylotic amyotrophy (CSA), Hirayama disease (HD), and spinobulbar muscular atrophy (SBMA) may present with intrinsic hand muscle atrophy. This study aimed to investigate different patterns of small hand muscle involvement in ALS and some mimic disorders. Methods: We compared the abductor digiti minimi/abductor pollicis brevis (ADM/APB) compound muscle action potential (CMAP) ratios between 200 ALS patients, 95 patients with distal-type CSA, 88 HD patients, 43 SBMA patients, and 150 normal controls. Results: The ADM/APB CMAP amplitude ratio was significantly higher in the ALS patients (P < 0.001) than that in the normal controls. The ADM/APB CMAP amplitude ratio was significantly reduced in the patients with distal-type CSA (P < 0.001) and the HD patients (P < 0.001) compared with that in the normal controls. The patients with distal-type CSA had significantly lower APB CMAP amplitude than the HD patients (P = 0.004). The ADM/APB CMAP amplitude ratio was significantly lower in the HD patients (P < 0.001) than that in the patients with distal-type CSA. The ADM/APB CMAP amplitude ratio of the SBMA patients was similar to that of the normal controls (P = 0.862). An absent APB CMAP and an abnormally high ADM/APB CMAP amplitude ratio (≥4.5) were observed exclusively in the ALS patients. Conclusions: The different patterns of small hand muscle atrophy between the ALS patients and the patients with mimic disorders presumably reflect distinct pathophysiological mechanisms underlying different disorders, and may aid in distinguishing between ALS and mimic disorders.
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Affiliation(s)
| | | | | | | | | | | | | | - Li-Ying Cui
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
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Bertelli JA, Ghizoni MF. Nerve and Free Gracilis Muscle Transfers for Thumb and Finger Extension Reconstruction in Long-standing Tetraplegia. J Hand Surg Am 2016; 41:e411-e416. [PMID: 27593485 DOI: 10.1016/j.jhsa.2016.08.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Revised: 05/09/2016] [Accepted: 08/01/2016] [Indexed: 02/02/2023]
Abstract
PURPOSE With spinal cord injuries, muscles below the level of the lesion remain innervated despite the absence of volitional control. This persistent innervation protects against denervation atrophy and may allow for nerve transfers to treat long-standing lesions within the spinal cord. We tested the hypothesis that in chronic spinal cord lesions, muscles remained viable for reinnervation. METHODS To test this hypothesis, we operated on 7 patients with tetraplegia to reconstruct thumb and finger extension after a mean interval of 5 years since injury. During surgery, if electrical stimulation of the posterior interosseous nerve (PIN) produced muscle contraction, the nerve to the supinator (NS) was transferred to the PIN. If no contractions were demonstrated, the muscles of the extensor compartment of the forearm were replaced via a free gracilis transfer with innervation supplied by the NS. RESULTS After an average of 26 months, M3 recovery of thumb and finger extension was observed in the 3 upper limbs from the 2 youngest patients who underwent a nerve transfer. None of the free gracilis-treated patients achieved scores above M2. CONCLUSIONS In our youngest patients aged 27 and 34 years, who were operated on 6 years after spinal cord injury, transfer of the NS to the PIN partially restored hand span. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic V.
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Affiliation(s)
- Jayme Augusto Bertelli
- Center of Biological and Health Sciences, Department of Neurosurgery, University of the South of Santa Catarina (Unisul), Tubarão, Santa Catarina, Brazil; Department of Orthopedic Surgery, Governador Celso Ramos Hospital, Florianópolis, Santa Catarina, Brazil.
| | - Marcos Flávio Ghizoni
- Center of Biological and Health Sciences, Department of Neurosurgery, University of the South of Santa Catarina (Unisul), Tubarão, Santa Catarina, Brazil
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Singh RJ, Preethish-Kumar V, Polavarapu K, Vengalil S, Prasad C, Nalini A. Reverse split hand syndrome: Dissociated intrinsic hand muscle atrophy pattern in Hirayama disease/brachial monomelic amyotrophy. Amyotroph Lateral Scler Frontotemporal Degener 2016; 18:10-16. [DOI: 10.1080/21678421.2016.1223140] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Ravinder-Jeet Singh
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, India,
| | - Veeramani Preethish-Kumar
- Department of Clinical Neurosciences, National Institute of Mental Health and Neurosciences, Bengaluru, India, and
| | - Kiran Polavarapu
- Department of Clinical Neurosciences, National Institute of Mental Health and Neurosciences, Bengaluru, India, and
| | - Seena Vengalil
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, India,
| | - Chandrajit Prasad
- Department of Neuroimaging and Interventional Radiology, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Atchayaram Nalini
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, India,
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Funaba M, Kanchiku T, Imajo Y, Suzuki H, Yoshida Y, Nishida N, Fujimoto K, Taguchi T. Characteristics of C6-7 myelopathy: assessment of clinical symptoms and electrophysiological findings. Spinal Cord 2015; 54:798-803. [PMID: 26572604 DOI: 10.1038/sc.2015.203] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2015] [Revised: 10/04/2015] [Accepted: 10/13/2015] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN This is a single-center retrospective study. OBJECTIVES The objective of this study was to study the clinical symptoms and electrophysiological features of C6-7 myelopathy. SETTING This study was conducted at the Department of Orthopedic surgery, Yamaguchi University Graduate school of medicine, Japan. METHODS A total of 20 patients with cervical compressive myelopathy were determined by spinal cord-evoked potentials or a single level of obvious magnetic resonance imaging (MRI)-documented cervical spinal cord compression. Neurological examinations included manual muscle testing and investigation of deep tendon reflex, including Hoffmann sign, and of sensory disturbance areas. Motor-evoked potentials (MEPs), compound muscle action potentials (CMAPs) and F-wave were recorded from bilateral abductor digit minim and abductor halluces muscles. Central motor conduction time was calculated as follows: MEPs latency-(CMAPs latency+F latency-1)/2 (ms). RESULTS Eighteen patients (90%) had negative Hoffmann sign. Eight patients (40%) had no sensory disturbance in the upper limbs and 8 patients (40%) had no muscle weakness in the upper limbs. We determined that patients had cervical myelopathy when their central motor conduction time measured in abductor digit minim was longer than 6.76 ms (+2 s.d.). Using this definition, the sensitivity for myelopathy was 42.8%. CONCLUSION Patients with C6-7 myelopathy may lack clinical symptoms in their hands and central motor conduction time measured in abductor digit minim tended to be less prolonged, and it only showed symptoms in their lower limbs as gait disturbance. Surgeons should bear in mind the possibility of disorders of caudal C6-7 when they encounter patients with no or few symptoms in their hands and with leg weakness or numbness.
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Affiliation(s)
- M Funaba
- Department of Orthopedic Surgery, Yamaguchi University Graduate School of Medicine, Ube city, Japan
| | - T Kanchiku
- Department of Orthopedic Surgery, Yamaguchi University Graduate School of Medicine, Ube city, Japan
| | - Y Imajo
- Department of Orthopedic Surgery, Yamaguchi University Graduate School of Medicine, Ube city, Japan
| | - H Suzuki
- Department of Orthopedic Surgery, Yamaguchi University Graduate School of Medicine, Ube city, Japan
| | - Y Yoshida
- Department of Orthopedic Surgery, Yamaguchi University Graduate School of Medicine, Ube city, Japan
| | - N Nishida
- Department of Orthopedic Surgery, Yamaguchi University Graduate School of Medicine, Ube city, Japan
| | - K Fujimoto
- Department of Orthopedic Surgery, Yamaguchi University Graduate School of Medicine, Ube city, Japan
| | - T Taguchi
- Department of Orthopedic Surgery, Yamaguchi University Graduate School of Medicine, Ube city, Japan
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Bertelli JA, Ghizoni MF, Tacca CP. Results of wrist extension reconstruction in C5-8 brachial plexus palsy by transferring the pronator quadratus motor branch to the extensor carpi radialis brevis muscle. J Neurosurg 2015; 124:1442-9. [PMID: 26430841 DOI: 10.3171/2015.3.jns142428] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT The objective of this study was to report the results of pronator quadratus (PQ) motor branch transfers to the extensor carpi radialis brevis (ECRB) motor branch to reconstruct wrist extension in C5-8 root lesions of the brachial plexus. METHODS Twenty-eight patients, averaging 24 years of age, with C5-8 root injuries underwent operations an average of 7 months after their accident. In 19 patients, wrist extension was impossible at baseline, whereas in 9 patients wrist extension was managed by activating thumb and wrist extensors. When these 9 patients grasped an object, their wrist dropped and grasp strength was lost. Wrist extension was reconstructed by transferring the PQ motor to the ECRB motor branch. After surgery, patients were followed for at least 12 months, with final follow-up an average of 22 months after surgery. RESULTS Successful reinnervation of the ECRB was demonstrated in 27 of the 28 patients. In 25 of the patients, wrist extension scored M4, and in 2 it scored M3. CONCLUSIONS In C5-8 root injuries, wrist extension can be predictably reconstructed by transferring the PQ motor branch to reinnervate the ECRB.
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Affiliation(s)
- Jayme Augusto Bertelli
- Department of Neurosurgery, Southern University of Santa Catarina (UNISUL), Tubarão; and.,Department of Orthopedic Surgery, Governador Celso Ramos Hospital, Florianópolis, Santa Catarina, Brazil
| | - Marcos Flávio Ghizoni
- Department of Neurosurgery, Southern University of Santa Catarina (UNISUL), Tubarão; and
| | - Cristiano Paulo Tacca
- Department of Orthopedic Surgery, Governador Celso Ramos Hospital, Florianópolis, Santa Catarina, Brazil
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A cadaveric study of the cervical nerve roots and spinal segments. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2015; 24:2828-31. [DOI: 10.1007/s00586-015-4070-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2015] [Revised: 04/22/2015] [Accepted: 06/09/2015] [Indexed: 10/23/2022]
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