Heuristic map of myotomal innervation in humans using direct intraoperative nerve root stimulation.
Heuristic map of myotomal innervation in humans using direct intraoperative nerve root stimulation.
复制标题
使用直接术中神经根刺激绘制人类肌节神经支配的启发式图。
DOI：
10.3171/2011.2.spine1068
复制
发表时间：
2011
期刊：
影响因子：
--
通讯作者：
S. Magge
中科院分区：
文献类型：
--
作者：
Clemens M. Schirmer;Clemens M. Schirmer;J. Shils;J. Arle;G. Cosgrove;P. Dempsey;E. Tarlov;Stephan Kim;Christopher J. Martin;C. Feltz;M. Moul;S. Magge
目的
不同肌肉的神经根支配存在相当大的重叠。肌节神经支配的知识对于解释神经系统检查结果和神经外科决策是必不可少的。以前的研究依赖于尸体解剖、动物研究和解剖异常的病例。本研究通过在体刺激的方法，探讨了脊髓减压术中肌节神经支配颈、腰神经根的规律。
方法
接受颈椎和腰椎手术的患者在正常手术过程中暴露神经根。肌电图电极被放置在肌肉群，通常被认为是受神经根的研究。这些位置包括接受减压的脊柱节段上方和下方的节段。减压后，将单极神经刺激器探针直接放置在神经根套管上，并以0.1 mA的增量进行恒定电流刺激。增加电流，直到在1块或多块肌肉中观察到至少100 μV振幅触发的肌电图反应。记录所有做出反应的肌肉。
结果
共刺激了129名患者（平均年龄57 ± 15岁，47名女性[36%]）的2295个神经根位置，1589个刺激符合质量标准并进行了分析。495次刺激是在C-3至T-1（31.2%）的颈丛和臂丛神经根上进行的，1094次（68.8%）是在L-1和S-2之间的腰骶丛神经根上进行的。作者能够构建每个颈和腰骶神经根对方案中监测的一组肌肉群的贡献的统计图。在许多情况下，由特定根支配的肌肉范围比以前在教科书中描述的更广。
结论
这是减压手术期间直接术中神经根刺激的最大数据集，证明了根水平运动输入对各种肌群的相对贡献。与经典的神经解剖学相比，显著数量的神经根支配的肌肉范围比预期的更广，这可能是具有相同数量和位置的受压神经根的患者之间表现的差异性的原因。
OBJECTIVE
Considerable overlap exists in nerve root innervation of various muscles. Knowledge of myotomal innervation is essential for the interpretation of neurological examination findings and neurosurgical decision-making. Previous studies relied on cadaveric dissections, animal studies, and cases with anomalous anatomy. This study investigates the myotomal innervation patterns of cervical and lumbar nerve roots through in vivo stimulation during surgeries for spinal decompression.
METHODS
Patients undergoing cervical and lumbar surgeries in which nerve roots were exposed in the normal course of surgery were included in the study. Electromyography electrodes were placed in the muscle groups that are generally accepted to be innervated by the roots under study. These locations included levels above and below the spinal levels undergoing decompression. After decompression, a unipolar neural stimulator probe was placed directly on the nerve root sleeve and constant current stimulation in increments of 0.1 mA was performed. Current was raised until at least a 100 μV amplitude-triggered electromyographic response was noted in 1 or more muscles. All muscles that responded were recorded.
RESULTS
A total of 2295 nerve root locations in 129 patients (mean age 57 ± 15 years, 47 female [36%]) were stimulated, and 1589 stimulations met quality criteria and were analyzed. Four hundred ninety-five stimulations were performed on roots contributing to the cervical and brachial plexus from C-3 to T-1 (31.2%), and 1094 (68.8%) were roots in the lumbosacral plexus between L-1 and S-2. The authors were able to construct a statistical map of the contributions of each cervical and lumbosacral nerve root for the set of muscle groups monitored in the protocol. In many cases the range of muscles innervated by a specific root was broader than previously described in textbooks.
CONCLUSIONS
This is the largest data set of direct intraoperative nerve root stimulations during decompressive surgery, demonstrating the relative contribution of root-level motor input to various muscle groups. Compared with classic neuroanatomy, a significant number of roots innervate a broader range of muscles than expected, which may account for the variability of presentation between patients with identical number and location of compressed roots.