1. Muscle responses to radicular stimulation during lumbo-sacral dorsal rhizotomy for spastic diplegia: Insights to myotome innervation.
- Author
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Georgoulis G and Sindou M
- Subjects
- Adolescent, Cerebral Palsy diagnostic imaging, Cerebral Palsy physiopathology, Child, Child, Preschool, Electromyography methods, Female, Humans, Lumbar Vertebrae diagnostic imaging, Lumbar Vertebrae innervation, Lumbar Vertebrae surgery, Male, Muscle, Skeletal diagnostic imaging, Muscle, Skeletal innervation, Prospective Studies, Sacrum diagnostic imaging, Sacrum innervation, Sacrum surgery, Spinal Nerve Roots diagnostic imaging, Cerebral Palsy surgery, Intraoperative Neurophysiological Monitoring methods, Muscle, Skeletal physiology, Rhizotomy methods, Spinal Nerve Roots physiology, Spinal Nerve Roots surgery
- Abstract
Objective: Most of knowledge on muscle radicular innervation was from explorations in root/spinal cord pathologies. Direct and individual access to each of the lumbar-sacral -ventral and dorsal- nerve roots during dorsal rhizotomy for spastic diplegia allows precise study of the corresponding muscle innervation. Authors report the lumbo-sacral segmental myotomal organization obtained from recordings of muscle responses to root stimulation in a 20-children prospective series., Methods: Seven key-muscles in each lower limb and anal sphincter were Electromyography (EMG)-recorded and clinically observed by physiotherapist during L2-to-S2 dorsal rhizotomy. Ventral roots (VR), for topographical mapping, and dorsal roots (DR), for segmental excitability testing, were stimulated, just above threshold for eliciting muscular response., Results: In 70% of the muscles studied, VR innervation was pluri-radicular, from 2-to-4 roots, with 1 or 2 roots being dominant at each level. Overlapping was important. Muscle responses to DR stimulation were 1.75 times more extended compared to VR stimulation. Inter-individual variability was important., Conclusions: Accuracy of root identification and stimulation with the used method brings some more precise information to radicular functional anatomy., Significance: Those neurophysiological findings plead for performing Intra-Operative Neuromonitoring when dealing with surgery in the lumbar-sacral roots., Competing Interests: Declaration of competing interest The authors have no conflict of interest, ethical adherence and any financial disclosures., (Copyright © 2020 International Federation of Clinical Neurophysiology. Published by Elsevier B.V. All rights reserved.)
- Published
- 2020
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