scholarly journals Somatotopic organization of the human spinothalamic tract: in vivo computed tomography–guided mapping in awake patients undergoing cordotomy

2019 ◽  
Vol 30 (5) ◽  
pp. 722-728
Author(s):  
C. Michael Honey ◽  
Zurab Ivanishvili ◽  
Christopher R. Honey ◽  
Manraj K. S. Heran
Keyword(s):  
Spinal Cord ◽  
Upper Limb ◽  
Lower Limb ◽  
Ct Imaging ◽  
Cervical Cord ◽  
Pain Patient ◽  
Spinothalamic Tract ◽  
Somatotopic Organization ◽  
Lower Limb Pain

OBJECTIVEThe location of the human spinothalamic tract (STT) in the anterolateral spinal cord has been known for more than a century. The exact nature of the neuronal fiber lamination within the STT, however, remains controversial. After correlating in vivo macrostimulation-induced pain/temperature sensation during percutaneous cervical cordotomy with simultaneous CT imaging of the electrode tip location, the authors present a modern description of the somatotopy of the human cervical STT.METHODSTwenty patients underwent CT-guided percutaneous cervical cordotomy to alleviate contralateral medication-refractory cancer pain. Patient responses to electrical stimulation (0.01–0.1 V, 50 Hz, 1 msec) were recorded and the electrode location for each response was documented with a contemporaneous CT scan. In a post hoc analysis of the data, the location for each patient’s response(s) was measured and drawn on a diagram of their cord. Positive responses were represented only when the lowest possible voltage (≤ 0.02 V) elicited a response. Negative responses were recorded if there was no clinical response at 0.1 V.RESULTSClinically, patients did well with an average reduction in opiates of 75% at 1 week, and 67% were able to leave the palliative care unit. The size of the cervical cord varied between patients, with an average lateral extent (width) of 11 mm and a height of 9 mm. Responses from the lower limb were represented superficially (lateral) and posteriorly within the anterolateral cord. The area with responses from the upper limb was larger and surrounded those with responses from the lower limb primarily anteriorly and medially, but also posteriorly.CONCLUSIONSIn this study, the somatotopic organization of the human STT was elucidated for the first time using in vivo macrostimulation and contemporaneous CT imaging during cordotomy. In this cohort of patients, the STT from the lower-limb region was located superficially and posteriorly in the anterolateral quadrant of the cervical cord, with the STT from the upper-limb region surrounding it primarily anteriorly and medially (deep) but also posteriorly. The authors discuss how the previous methods of cordotomy may have biased the earlier versions of STT lamination. They suggest that an ideal spinal cord entry site for cordotomy of either the upper- or lower-limb pain fibers is halfway between the equator and anterior pole of the cord.

scholarly journals Defining the Somatotopy of the Human Spinothalamic Tract: Computed Tomography Guided Mapping and Physiologic Responses in Patients Undergoing Awake Percutaneous Cervical Cordotomy

Neurosurgery ◽  
2019 ◽  
Vol 66 (Supplement_1) ◽  
Author(s):  
Michael Honey ◽  
Zurab Ivanishvili ◽  
Christopher Honey ◽  
Manraj S Heran
Keyword(s):  
Computed Tomography ◽  
Upper Limb ◽  
Lower Limb ◽  
Contralateral Side ◽  
Pain Patient ◽  
Spinothalamic Tract ◽  
Ct Guided ◽  
Somatotopic Organization ◽  
Patient Responses

Abstract INTRODUCTION There exist 2 very different models of somatotopic organization of the spinothalamic tract (STT) in the literature: medial-to-lateral and anterior-to-posterior lamination. After correlating in Vivo macrostimulation-induced pain or temperature sensation during percutaneous cervical cordotomy with simultaneous computed tomography (CT) imaging of the electrode tip location, we present a modern description of the somatotopy of the human cervical spinothalamic tract. METHODS A total of 20 patients underwent CT-guided percutaneous cervical cordotomy to alleviate contralateral medication-refractory cancer pain. Patient responses to electrical stimulation were recorded and the electrode location for each response was documented with a contemporaneous CT scan. RESULTS Clinically the patients did well. Maximal daily pain on the contralateral side was significantly reduced (P < .001, paired t-test) from a preoperative 9.3 ± 0.5 (VAS mean ± sd) to 0.5 ± 1.2 on the first postoperative day. The average reduction in opiate medications, as measured by morphine equivalents, was 75% over 1 wk (range 40%-98%). Responses from the lower limb were represented superficially (lateral) and posteriorly within the anterolateral cord. The area with responses from the upper limb was larger and surrounded those with responses from the lower limb primarily anteriorly and medially. CONCLUSION Our work simultaneously combined awake physiologic localization of fibers within the human spinothalamic tract with neuroimaging documenting their precise anatomical localization within the spinal cord. The resultant map of the STT demonstrates, for the first time, that fibers from the lower limb are located superficially and posteriorly within the anterolateral cord with the fibers from the upper limb surrounding them primarily deep and anteriorly but also posteriorly. If these results are confirmed by others, it will solve the century-long controversy of lamination patterns within the STT and add a small but fundamental piece of knowledge to our understanding of human neuroanatomy.

scholarly journals C.06 Somatotopic organization of the human spinothalamic tract: CT-guided mapping in awake patients undergoing cordotomy

2018 ◽  
Vol 45 (s2) ◽  
pp. S15-S15
Author(s):  
CM Honey ◽  
Z Ivanishvili ◽  
CR Honey ◽  
MK Heran
Keyword(s):  
Spinal Cord ◽  
Upper Limb ◽  
Lower Limb ◽  
Cervical Spinal Cord ◽  
Induced Response ◽  
Spinothalamic Tract ◽  
Ct Guided ◽  
Somatotopic Organization ◽  
Anatomical Localization

Background: After correlating in vivo macrostimulation-induced pain or temperature sensation during percutaneous cervical cordotomy with simultaneous CT imaging of the electrode tip location, we present a modern description of the somatotopy of the human cervical spinothalamic tract Methods: Twenty patients with medically refractory, unilateral, nociceptive pain due to malignancy received contralateral cervical percutaneous cordotomy. In a post-hoc analysis of the data, each individual’s cervical spinal cord was measured from the CT image using PACS software. The location of the electrode tip during each stimulation-induced response was then superimposed on a diagram of their cord Results: The lower limb responses were found more superficial and posterior to those of the upper limb. Interestingly, the region for upper limb responses surrounded that for lower limb primarily anteriorly and medially (deep) but also posteriorly Conclusions: This work simultaneously combined awake physiologic localization of fibers within the human -spinothalamic tract (STT) with neuroimaging documenting their precise anatomical localization within the spinal cord. The resultant map of the STT demonstrates, for the first time, that fibers from the lower limb are located superficially and posteriorly within the anterolateral spinal cord with the fibers from the upper limb surrounding them primarily deep and anteriorly but also posteriorly

scholarly journals Muscle perfusion of posterior trunk and lower-limb muscles at rest and during upper-limb exercise in spinal cord-injured and able-bodied individuals

Spinal Cord ◽  
2012 ◽  
Vol 50 (11) ◽  
pp. 822-826 ◽  
Author(s):  
A Zafeiridis ◽  
A V Vasiliadis ◽  
A Doumas ◽  
N Galanis ◽  
T Christoforidis ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Upper Limb ◽  
Lower Limb ◽  
Muscle Perfusion ◽  
Lower Limb Muscles ◽  
Limb Muscles ◽  
Posterior Trunk ◽  
Spinal Cord Injured ◽  
Limb Exercise

Bit-colour mapping of seps during spinal cord stimulation (SCS) in chronic lower limb pain due to PVD

Pain ◽  
1990 ◽  
Vol 41 ◽  
pp. S83
Author(s):  
P. Cisotto ◽  
S. Cusumano ◽  
P.L. Longatti ◽  
G. Trincia ◽  
A. Carteri
Keyword(s):  
Spinal Cord ◽  
Lower Limb ◽  
Spinal Cord Stimulation ◽  
Limb Pain ◽  
Lower Limb Pain

scholarly journals Cervical Cord Compression With Lower Limbs Sensory Disturbance Presentation: Three Case Reports and Literature Review

2021 ◽  
Author(s):  
Yafei Cao ◽  
Yihong Wu ◽  
Weiji Yu ◽  
Weidong Liu ◽  
Shufen Sun ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Compression ◽  
Lower Limb ◽  
Cord Compression ◽  
Lower Limbs ◽  
Anterior Cervical Discectomy ◽  
Cervical Cord ◽  
Sensory Disturbance ◽  
Cervical Discectomy ◽  
Sensory Disturbances

Abstract Background: Lower limb sensory disturbance presentation can be a false localizing cervical cord compressive myelopathy (CSM). It may lead to delayed or missed diagnosis, resulting in the wrong management plan, especially in the presence of concurrent lumbar lesions.Case presentation:Three Asian patients with lower limb sensory disturbances presentation were treated ineffectively in the lumbar. Magnetic resonance imaging (MRI) showed cervical disc herniation and cervical level spinal cord compression. Anterior cervical discectomy surgery and zero-p interbody fusion were performed. After operations, imagings showed that the spinal cord compression were relieved, and the lower limbs sensory disturbances were also relieved. Three-months follow-up after operation showed good recovery.Conclusions:These three cervical cord compression cases of lower limb sensory disturbance presentation were easily misdiagnosed with lumbar spondylosis. Anterior cervical discectomy and fusion operation had a good therapeutic effect. Therefore, cases that present with lower limb sensory disturbance, but in a non-radicular classical pattern, should always alert a suspicion of a possible cord compression cause at a higher level.

scholarly journals The utility of upper limb loading device in determining optimal walking ability in ambulatory individuals with spinal cord injury

2021 ◽  
pp. 1-9
Author(s):  
Makamas Kumprou ◽  
Pipatana Amatachaya ◽  
Thanat Sooknuan ◽  
Preeda Arayawichanon ◽  
Thiwabhorn Thaweewannakij ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Upper Limb ◽  
Lower Limb ◽  
Weight Bearing ◽  
Walking Ability ◽  
Limb Loading ◽  
Cord Injury ◽  
Loading Device ◽  
Walking Performance

Background: Walking devices are frequently prescribed for many individuals, including those with spinal cord injury (SCI), to promote their independence. However, without proper screening and follow-up care, the individuals may continue using the same device when their conditions have progressed, that may possibly worsen their walking ability. Objective: This study developed an upper limb loading device (ULLD), and assessed the possibility of using the tool to determine the optimal walking ability of ambulatory participants with SCI who used a walking device daily ([Formula: see text]). Methods: All participants were assessed for their optimal walking ability, i.e., the ability of walking with the least support device or no device as they could do safely and confidently. The participants were also assessed for their amount of weight-bearing on the upper limbs or upper limb loading while walking, amount of weight-bearing on the lower limbs or lower limb loading while stepping of the other leg, and walking performance. Results: The findings indicated that approximately one third of the participants (31%) could progress their walking ability from their current ability, whereby four participants could even walk without a walking device. The amount of upper limb loading while walking, lower limb loading ability, and walking performance were significantly different among the groups of optimal walking ability ([Formula: see text]). Furthermore, the amount of upper limb loading showed negative correlation to the amount of lower limb loading and walking performance ([Formula: see text] to [Formula: see text]0.493, [Formula: see text]). Conclusion: The findings suggest the potential benefit of using the upper limb loading device and the amount of upper limb loading for walking device prescription, and monitoring the change of walking ability among ambulatory individuals with SCI.

scholarly journals Lower limb conduit artery endothelial responses to acute upper limb exercise in spinal cord injured and able-bodied men

2015 ◽  
Vol 3 (4) ◽  
pp. e12367 ◽  
Author(s):  
Julia O. Totosy de Zepetnek ◽  
Jason S. Au ◽  
David S. Ditor ◽  
Maureen J. MacDonald
Keyword(s):  
Spinal Cord ◽  
Upper Limb ◽  
Lower Limb ◽  
Conduit Artery ◽  
Spinal Cord Injured ◽  
Limb Exercise

Topographic specificity of corticospinal connections formed in explant coculture

Development ◽  
1994 ◽  
Vol 120 (7) ◽  
pp. 1937-1947 ◽  
Author(s):  
R.Z. Kuang ◽  
M. Merline ◽  
K. Kalil
Keyword(s):  
Spinal Cord ◽  
Sensorimotor Cortex ◽  
Target Selection ◽  
Cervical Cord ◽  
Target Tissue ◽  
Early Postnatal Development ◽  
Axon Collaterals ◽  
Visual Cortical

The corticospinal pathway connects layer V pyramidal neurons in discrete regions of the sensorimotor cortex to topographically matching targets in the spinal cord. In rodents initial pathway errors occur transiently during early postnatal development, such that visual cortical axons project inappropriately into the corticospinal tract. Nevertheless, only sensorimotor axons form corticospinal connections, which are topographically ordered in hamsters from the earliest stages of innervation. Previous work in vivo suggests that pathfinding is carried out by primary cortical axons whereas target innervation occurs by extension of axon collaterals at appropriate locations. In vitro studies have provided evidence that chemotropic factors may selectively attract extension of neurites into specific targets. To investigate the basis for corticospinal target selection during development, we have used an in vitro explant coculture system. Sensorimotor and visual cortical explants from newborn hamsters were presented with inappropriate targets from olfactory bulb and cerebellum and targets from the cervical (forelimb) and lumbar (hindlimb) enlargements of the early postnatal spinal cord. Under in vitro conditions, corticospinal target selection was highly specific and remarkably similar to corticospinal connectivity in vivo. Visual and sensorimotor cortical neurites extended nonselectively into the white matter of the spinal cord. However, only neurites from the sensorimotor cortex were able to extend into and arborize within the spinal gray. In the majority of cases, these connections were topographically appropriate, matching forelimb cortex to cervical cord and hindlimb cortex to lumbar cord. However, we found no evidence that chemotropic attraction was responsible for selection of appropriate targets by cortical neurites or that spinal target tissue promoted extension of cortical axon collaterals within the collagen matrix. These results suggest that the ability of cortical neurites to recognize correct spinal targets and form terminal arbors may require direct axon target interaction.

Effects of rectal distensions on nociceptive flexion reflexes in humans

1998 ◽  
Vol 275 (3) ◽  
pp. G410-G417 ◽  
Author(s):  
Didier Bouhassira ◽  
Jean-Marc Sabaté ◽  
Benoit Coffin ◽  
Daniel Le Bars ◽  
Jean-Claude Willer ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Healthy Volunteers ◽  
Upper Limb ◽  
Lower Limb ◽  
Pain Modulation ◽  
Gastric Distension ◽  
Visceral Sensation ◽  
Differential Effects

We previously showed that gastric distension inhibits the somatic nociceptive flexion RIII reflex. To explore further the viscerosomatic interactions, we tested in the present study the effects of rectal distensions on RIII reflexes. Rapid and slow-ramp rectal distensions were performed in 10 healthy volunteers with an electronic barostat. The RIII reflex was continuously recorded from the lower limb during both types of distension and from the upper limb during rapid distensions. The visceral sensations were scored on a graded questionnaire. Rapid distensions facilitated the RIII reflex recorded from the lower limb, but at the highest distension level, facilitation was followed by inhibition. Slow-ramp distension induced gradual inhibition of the RIII reflex, which correlated with both distension volume and visceral sensation. RIII reflex recorded from the upper limb was also inhibited by rapid rectal distensions. Reflex inhibitions were probably related to the activation of pain modulation systems. One plausible explanation for the facilitatory effects, observed only at the lower limb, is the convergence of rectal and reflex afferents at the same levels of the spinal cord. The differential effects of rapid and slow-ramp distensions suggest the activation of two distinct populations of mechanoreceptors by these two modes of distension.

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