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Spinal Injuries
Published in Ian Greaves, Keith Porter, Jeff Garner, Trauma Care Manual, 2021
Ian Greaves, Keith Porter, Jeff Garner
The spinal cord is divided into 31 segments each with a pair of anterior (motor) and dorsal (sensory) spinal nerve roots. On each side, the anterior and dorsal nerve roots combine to form the spinal nerves as they exit from the vertebral column. Each segmental nerve root supplies motor innervation to specific muscle groups (myotomes) and sensory innervation to a specific area of skin (dermatome). By testing sensory modalities and motor functions, it is possible to localize any neurological abnormality to specific spinal levels. The neurological level of injury is the lowest (most caudal) segmental level with normal sensory and motor function. A patient with a C5 level exhibits, by definition, abnormal motor and sensory function from C6 down. It is important to remember that the spinal cord segments do not correspond to the vertebral levels.
Percutaneous spinal interventions and pain management
Published in Michael Y. Wang, Andrea L. Strayer, Odette A. Harris, Cathy M. Rosenberg, Praveen V. Mummaneni, Handbook of Neurosurgery, Neurology, and Spinal Medicine for Nurses and Advanced Practice Health Professionals, 2017
Radicular pain is pain referred from a spinal nerve root along one or more dermatomes or myotomes of an extremity. In the case of spinal disc hernation/extrusion upper/lower limb pain is usually greater and more intense than axial spine pain. Weakness may or may not be present with a radiculitis, but it should provide heightened concern for advanced imaging and referral to a spine specialist if weakness is progressive or accompanied by bowel or bladder incontinence. Proper diagnostic testing is important to determine if the extremity pain is the result of nerve root inflammation, compression, or some other confounding peripheral cause (e.g.. peripheral neuropathy, carpal tunnel, ulnar neuropathy, brachial/lumbar plexopathy, amyotrophy, etc.). Common mimics of lumbar radiculopathy include inflammatory bursitis, iliotibial band syndrome, rotator cuff syndrome, femoral acetabular impingement, osteoarthritis of the hip/shoulder, elbow/knee/wrist pathology, trochanteric bursitis, or hip fracture.
The spine
Published in Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie, Bailey & Love's Short Practice of Surgery, 2018
Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie
The spinal nerve roots comprise 8 cervical, 12 thoracic, 5 lumbar, 5 sacral and 1 coccygeal. Dorsal and ventral roots join to form spinal nerves. The ventral root and the dorsal root ganglion lie within the intervertebral foramen. This foramen is bounded superiorly and inferiorly by pedicles, anteriorly by the disc and posteriorly by the facet joint. Degenerative changes in these structures may lead to neural compromise. Laminar overlap within the lumbar spine decreases from L1 to S1 so that, at the L5-S1 level, access to the intervertebral disc requires less bone removal than at a more proximal level.
Cervical spine thrust and non-thrust mobilization for the management of recalcitrant C6 paresthesias associated with a cervical radiculopathy: a case report
Published in Physiotherapy Theory and Practice, 2022
Christopher R. Hagan,, Alexandra R. Anderson,
Using the diagnostic test cluster by Wainner et al. (2003) to assist the diagnosis, the patient was found to test positive on 3 tests: cervical rotation <45 degrees, cervical distraction (Sn 0.44, Sp 0.90), and Spurling’s test (Sn 0.50, Sp 0.86). The patient also tested positive for median nerve provocation, but this test was modified due to patient irritability and cannot be included in the diagnostic test cluster. The post-test probability for the presence of cervical radiculopathy is estimated to be 65% with three positive tests (Wainner et al., 2003). After consideration of all examination findings, the clinical impression was cervical radiculopathy affecting the C6 spinal nerve root. This impression was supported by the three positive diagnostic tests, positive neural provocation findings, sensation deficits of the first and second digits, as well as myotomal weakness consistent with the C6 nerve root (Caridi, Pumberger, and Hughes, 2011; Downs and Laporte, 2011; Lee, McPhee, and Stringer, 2008).
Ultrasound-guided injection acupotomy as a minimally invasive intervention therapy for cervical spondylotic radiculopathy: a randomized control trial
Published in Annals of Medicine, 2023
Jianfeng Pu, Wenping Cao, Yetin Chen, Yunwu Fan, Ye Cao
Cervical spondylotic radiculopathy (CSR) is a common disease in the department of pain, accounting for about 60–70% of all cervical spondylosis [1]. It is mainly caused by the stimulation or compression of unilateral or bilateral spinal nerve roots. Symptoms include sensory, motor, and reflex disturbances consistent with the distribution of spinal nerve roots. The most common age for CSR is 50–60 years old [2, 3]. About two per 1,000 middle-aged people suffer from CSR every year [4]. An epidemiological survey of CSR in the USA found that about 83.2 per 100,000 people suffer from this condition [5].