Document Detail

Intradural cervical root adjacent interconnections in the normal, prefixed, and postfixed brachial plexus.
MedLine Citation:
PMID:  19929336     Owner:  NLM     Status:  MEDLINE    
OBJECT: Intradural intercommunications between adjacent nerve roots have received scant attention in the literature. Moreover, the pattern of these connections among individuals harboring normal, pre-, and postfixed brachial plexuses, to the authors' knowledge, has not been explored. METHODS: Sixty adult cadavers were evaluated for the presence of a normal, prefixed, or postfixed brachial plexus. Next, with the cadaver placed prone, laminectomies of all cervical and the upper thoracic vertebrae were performed. The dura mater was opened and observations were made for the presence of neural intercommunications between the roots of adjacent spinal levels. Any correlations between such root communications and pre- and postfixed brachial plexuses were explored. RESULTS: Among the cadavers, 28% harbored prefixed and 5% harbored postfixed brachial plexuses. Intercommunications between adjacent dorsal roots were more or less equally distributed between left and right sides. A total of 134 interconnections were identified between C-1 and T-2 levels. No interconnection spanned more than one spinal segment. When all sides were included, in ascending order based on the number of interconnections present, interconnections between roots were found between T-1 and T-2, C-1 and C-2, C-8 and T-1, C-2 and C-3, C-3 and C-4, C-4 and C-5, C-7 and C-8, C-6 and C-7, and C-5 and C-6. In this same order, the percent of total connections for each of these levels was 0, 0.8, 2, 7, 13, 15, 16, 20, and 25%. For left and right sides, a total of 73 and 61 interconnections were identified, respectively. This order of concentration was found to have no statistical difference between cadavers that had a normal arrangement of the brachial plexus, a prefixed brachial plexus, or a postfixed brachial plexus. No specimen was found to have interconnections between adjacent ventral roots. CONCLUSIONS: Such variations as intradural interconnections may lead to misinterpretation of spinal levels harboring pathological entities of the spinal axis and should be considered during surgical procedures of this region such as rhizotomy. However, the present study did not find a correlation between the level of these interconnections and whether the brachial plexus was pre- or postfixed (that is, there were no observable shifts intradurally that corresponded to the extradural segmental contributions to the brachial plexus).
R Shane Tubbs; Diala El-Zammar; Marios Loukas; Ayhan C??mert; Aaron A Cohen-Gadol
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Journal of neurosurgery. Spine     Volume:  11     ISSN:  1547-5646     ISO Abbreviation:  -     Publication Date:  2009 Oct 
Date Detail:
Created Date:  2009-11-25     Completed Date:  2009-12-30     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101223545     Medline TA:  J Neurosurg Spine     Country:  United States    
Other Details:
Languages:  eng     Pagination:  413-6     Citation Subset:  IM    
Section of Pediatric Neurosurgery, Children's Hospital, Birmingham, Alabama 35233, USA.
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MeSH Terms
Brachial Plexus / anatomy & histology*
Cervical Vertebrae / innervation*
Neck / anatomy & histology,  innervation
Spinal Nerve Roots / anatomy & histology*
Tissue Fixation

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