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Radicular avulsion resulting from spinal injury: assessment of diagnostic modalities

Summary

The diagnostic utility of imaging techniques in injuries to the intramedullary and subarachnoid portions of the brachial plexus, with possibly complete avulsion of one or more nerve roots from the spinal cord and extramedullary meningocoele was compared in 18 patients studied by unenhanced computed tomography (CT), cervical myelography, myelographic CT (MCT) and magnetic resonance imaging (MRI). Emphasis was placed on the lesions of the subarachnoid roots. CM was the only diagnostic modality to show avulsion of 18 nerve roots and their levels in 8 patients (100% = gold standard), and to verify 2 incomplete avulsions. MCT reliably revealed 8 of 18 (45%) and MRI 1 out of 18 (6%) avulsions. Myelography with MCT showed intact subarachnoid nerve roots in 10 additional patients. MRI and MCT (16 out of 16=100%) were superior to myelography (14/16=88%) for demonstrating 16 traumatic meningocoeles in 8 patients; follow-up MRI (6–24 months) showed no increase in their size. We recommend a subsequent CT to role out fracture to the spinal column; MRI should provide significant information concerning oedema or haemorrhage in the spinal cord. Myelography with segmental MCT is performed to differentiate pre- from post-ganglionic lesions. data which are essential for deciding whether exploration of the plexus or a motor substitution operation is indicated.

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References

  1. 1.

    Alnot JY (1987) Traumatic paralysis of the brachial plexus: preoperative problems and therapeutic indications. In: Terzis JK (ed) Microreconstruction of nerve injuries. Saunders, Philadelphia; pp 325–345

  2. 2.

    Birch R (1987) Brachial plexus injuries. Curr Orthop 1:316–323

  3. 3.

    Millesi H (1987) Brachial plexus injuries: management and results. In: Terzis JK (ed) Microreconstruction of nerve injuries. Saunders, Philadelphia, pp 347–360

  4. 4.

    Taylor PE (1962) Traumatic intradural avulsion of the nerve roots of the brachial plexus. Brain 85:579–602

  5. 5.

    Murphey F, Hartung W, Kirklin JW (1947) Myelographic demonstration of avulsing injury of the brachial plexus. Am J Roentgenol 58:102–105

  6. 6.

    Yeoman PM (1968) Cervical myelography in traction injuries of the brachial plexus. J Bone Joint Surg [Br] 50:253–260

  7. 7.

    Frot B, Filipe G, Olivier H, Alnot JY, Duparc J (1973) Interêt de la myelographie cervicale à contraste positif dans l'exploration des lésions traumatiques du plexus brachial chez l'adulte. Ann Radiol 16:715–721

  8. 8.

    Wiedenmann O (1963) Neurologische Störungen als Folge von Ausrißverletzungen des Plexus brachialis im Vergleich zu den Befunden des positiven Myelogramms. Z Orthop 97:67–78

  9. 9.

    Piepgras U, Jelasic F, Kammerer V, Traupe H (1975) Radiologische Befunde bei zervikalen Wurzelausrissen. Radiologe 15: 317–322

  10. 10.

    Neuenschwander S, Brauner M, Gilbert A, Faure C (1980) La myelographie cervicale à la metrizamide dans les paralysies obstétricales du plexus brachial. Ann Radiol 23:93–98

  11. 11.

    Petras AF, Sobel DF, Mani JR, Lucas PR (1985) CT myelography in cervical root avulsion. J Comput Assist Tomogr 9:275–279

  12. 12.

    Marshall RW, De Silva RDD (1986) Computerized axial tomography in traction injuries of the brachial plexus. J Bone Joint Surg [Br] 68:734–738

  13. 13.

    Cobby MJD, Leslie IJ, Watt I (1988) Cervical myelography of nerve root avulsion injuries using water-soluble contrast media. Br J Radiol 61:673–678

  14. 14.

    Armington WG, Harnsberger HR, Osborn AG, Seay AR (1987) Radiographic evaluation of brachial plexopathy. AJNR 8:361–367

  15. 15.

    Gupta RK, Mehta VS, Banerji AK, Jain RK (1989) MR evaluation of brachial plexus injuries. Neuroradiology 31:377–381

  16. 16.

    Volle E, Hedde JP, Gormanns R (1991) Die direkte zervikale Myelographie mit Iotrolan 300. RÖFO 154:87–91

  17. 17.

    Sander B, Henkes H, Lutz N, Felix R (1989) Der Einfluß von Röntgenkontrastmitteln bei der Magnetresonanztomographie des Spinalkanals. Röntgen-Bl 42:343–345

  18. 18.

    Amundsen P, Skalpe IO (1975) Cervical myelography with a water-soluble contrast medium (metrizamide). Neuroradiology 8:209–212

  19. 19.

    Leo JS, Bergeron T, Kricheff II, Benjamin MV (1978) Metrizamide myelography for cervical spinal cord injuries. Radiology 129:707–711

  20. 20.

    Raininko R, Sonningen P (1987) Dorsal CSF space at CI-CII level. Neuroradiology 29:73–75

  21. 21.

    Dawson P, Howell M (1986) The non-ionic dimers: a new class of contrast agents. Br J Radiol 59:987–991

  22. 22.

    Harwood-Nash DCF, Petterson H (1982) CT myelography of the spine and cord. Springer, New York Berlin Heidelberg, pp 12–14

  23. 23.

    Verstraete KLA, Martens F, Smeets P, Vandekerckhove T, Meire D, Parizel PM, Van de Velde E, Calliaux L (1989) Traumatic lumbosacral nerve root meningoceles. Neuroradiology 31:425–429

  24. 24.

    Stohr M, Riffel B, Buettner US (1981) Somatosensibel evozierte Potentiale in der Diagnostik von Armplexusläsionen. EEG EMG 12:195–197

  25. 25.

    Hashimoto T, Mitomo M, Hirabuki N, Miura T, Kawai R, Nakamura H, Kawai H, Ono K, Kozuka T (1991) Nerve root avulsion of birth palsy: comparison of myelography with CT myelography and somatosensory evoked potentials. Radiology 178:841–845

  26. 26.

    Flanders AE, Schaefer DM, Doan AT, Mishkin MM, Gonzalez CF, Northrup BE (1990) Acute cervical spine trauma: correlation of MR imaging findings with degree of neurologic deficit. Radiology 177:25–33

  27. 27.

    Enzmann DR, De LaPaz R, Rubin JB (1990) Magnetic resonance of the spine, 1st edn. Mosby, St. Louis, pp 250–259

  28. 28.

    Penfield W (1949) Late spinal paralysis after avulsion of the brachial plexus. J Bone Joint Surg [Br] 31:40–41

  29. 29.

    Robertson HJ, Smith RD (1990) Cervical myelography: survey of modes of practice and major complications. Radiology 174: 79–83

  30. 30.

    Skalpe IO (1990) Cervical myelography (letter to the editor). Radiology 177:590–591

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Volle, E., Assheuer, J., Hedde, J.P. et al. Radicular avulsion resulting from spinal injury: assessment of diagnostic modalities. Neuroradiology 34, 235–240 (1992). https://doi.org/10.1007/BF00596345

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Key words

  • Spinal cord, injuries
  • Spinal cord, MR studies
  • Nerve root avulsion
  • Contrast media
  • Cervical myelography