Distribution Patterns of Vasculature Around Cervical Nerve Roots

Diagnosis and Treatment of Cervical Spondylotic Radiculopathy Using Selective Nerve Root Block (SNRB): Where are We Now?

Cervical spondylotic radiculopathy (CSR) is one of the most common degenerative diseases of the spine that is commonly treated with surgery. The primary goal of surgery is to relieve symptoms through decompression or relieving pressure on compressed cervical nerves. Nevertheless, cutaneous pain distribution is not always predictable, making accurate diagnosis challenging and increasing the likelihood of inadequate surgical outcomes. With the widespread application of minimally invasive surgical techniques, the requirement for precise preoperative localization of the affected segments has become critical, especially when treating patients with multi-segmental CSR. Recently, the preoperative use of a selective nerve root block (SNRB) to localize the specific nerve roots involved in CSR has increased. However, few reviews discuss the currently used block approaches, risk factors, and other aspects of concern voiced by surgeons carrying out SNRB. This review summarized the main cervical SNRB approaches currently used clinically and the relevant technical details. Methods that can be used to decrease risk during cervical SNRB procedures, including choice of steroids, vessel avoidance, guidance with radiographs or ultra-sound, contrast agent usage, and other concerns, also are discussed. We concluded that a comprehensive understanding of the current techniques used for cervical SNRB would allow surgeons to perform cervical SNRB more safely.

Findings of Electrodiagnostic Studies in Moderate to Severe Lumbar Central Spinal Stenosis-Electrodiagnostic Studies in Lumbar Central Spinal Stenosis

Purpose: The purpose of this study was to investigate the findings of electrodiagnostic studies (nerve conduction study (NCS) and electromyography (EMG)) in patients with moderate and severe lumbar central spinal stenosis (LCSS). Methods: We retrospectively reviewed the medical records of Ulsan University Hospital and identified 32 consecutive patients (mean age = 66.9 ± 7.4 years; male:female = 8:24) with LCSS. Based on the results of T2 axial magnetic resonance imaging at the level of L4–5, patients were categorized as having severe (n = 14) or moderate LCSS (n = 18). Results from NCS and EMG were retrieved. Additionally, we included 15 age- and sex-matched volunteers without LCSS (mean age = 65.2 ± 8.0 years; male:female = 4:11) to serve as a control group. Results of NCS and EMG were compared between the three groups. Results: We found that, compared to normal subjects, patients with moderate or severe LCSS presented significantly lower distal amplitudes of the compound motor action potential of both peroneal and tibial nerves. Regarding EMG, positive sharp waves and fibrillation potentials were exclusively observed in patients with severe LCSS group (28.6%). Conclusion: Electrodiagnostic studies were significantly altered in patients with moderate and severe LCSS. Our results may be helpful to diagnose LCSS-induced radiculopathy and to differentiate it from other causes of peripheral nerve pathologies.