Segmental innervation: a graphic synthesis of correspondence between dermatomes, myotomes, sclerotomes and viscerotomes. Systematic review of existing works and publications about dermatomes, myotomes, sclerotomes and viscerotomes aimed to design a graphic synthesis of somato-visceral correspondences

This article proposes a graphic synthesis in the form of an illustration of somato-visceral correspondences achieved through a literature review of existing publications about dermatomes, myotomes, sclerotomes and viscerotomes. Fundamental concepts of osteopathy, correspondence of the medullary levels of innervation between the somatic structures and visceral organs is proposed in the form of a graphic synthesis.The goal of research. Relevant studies in French, English and German language have been collected. Dedicated search engines, Google Scholar, JSTOR Search, MEDLINE / Pubmed, Web of Science have been consulted as well as all specifi c medical libraries accessible on-line and on-site. Synthesis of collected data has been used to design correspondences between dermatomes, myotomes, sclerotomes and viscerotomes.Conclusion. The aim of this systematic review suggests a graphical synthesis correspondence of the innervation areas in human body between somatic structures and visceral structures and organs. These illustrations of a neurological correspondence between structures highlight the principles of global management for a person carrying somatic dysfunctions. Further experimental investigations using imaging tools and current technological advances should help to a more complete elaboration of neurological correspondences between structures as well as understand the process of osteopathic therapy effectiveness.

Case 2

Low back pain with or without lumbosacral root compression is an extremely common clinical situation presenting to primary care physicians and specialists. This case illustrates a patient with lumbosacral radiculopathy due to vertebral disc herniation, supplemented by several magnetic resonance imaging images and diagrams that enhance the pathophysiology of this disorder. A discussion of the anatomy is followed by the clinical findings of various individual lumbosacral radiculopathies. The findings on electrodiagnostic studies are detailed with emphasis on myotomal and segmental innervation of muscles in the lower extremity. The advantages and limitations of the electrodiagnostic studies in patients with suspected lumbosacral radiculopathy are thoroughly debated. A discussion of the findings in lumbar canal stenosis completes this section.

The Anatomy of the Lateral Branches of the Sacral Dorsal Rami: Implications for Radiofrequency Ablation

Background: The sacroiliac joint (SIJ) is a major source of pain in patients with chronic low back pain. Radiofrequency ablation (RFA) of the lateral branches of the dorsal sacral rami that supply the joint is a treatment option gaining considerable attention. However, the position of the lateral branches (commonly targeted with RFA) is variable and the segmental innervation to the SIJ is not well understood. Objectives: Our objective was to clarify the lateral branches’ innervation of the SIJ and their specific locations in relation to the dorsal sacral foramina, which are the standard RFA landmark. Methods: Dissections and photography of the L5 to S4 sacral dorsal rami were performed on 12 hemipelves from 9 donated cadaveric specimens. Results: There was a broad range of exit points from the dorsal sacral foramina: ranging from 12:00 – 6:00 position on the right side and 6:00 – 12:00 on the left positions. Nine of 12 of the hemipelves showed anastomosing branches from L5 dorsal rami to the S1 lateral plexus. Limitations: The limitations of this study include the use of a posterior approach to the pelvic dissection only, thus discounting any possible nerve contribution to the anterior aspect of the SIJ, as well as the possible destruction of some L5 or sacral dorsal rami branches with the removal of the ligaments and muscles of the low back. Conclusion: Widespread variability of lateral branch exit points from the dorsal sacral foramen and possible contributions from L5 dorsal rami and superior gluteal nerve were disclosed by the current study. Hence, SIJ RFA treatment approaches need to incorporate techniques which address the diverse SIJ innervation. Key words: Sacroiliac joint pain, radiofrequency ablation, dorsal sacral rami, low back pain