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[Myelography for nerve root avulsion in birth palsy]
T Hashimoto1, M Mitomo, N Hirabuki
1Department of Radiology, Osaka University Medical School.
Nihon Igaku Hoshasen Gakkai Zasshi. Nippon Acta Radiologica
|April 25, 1990
Summary
Myelography is essential for diagnosing nerve root avulsions in birth palsy, especially when meningoceles are absent. CT myelography aids in detecting meningoceles but is less accurate for avulsion diagnosis.
Area of Science:
- Neurology
- Radiology
- Pediatric Orthopedics
Background:
- Birth palsy can cause nerve root avulsion injuries.
- Accurate diagnosis of nerve root avulsions is crucial for effective treatment planning.
Purpose of the Study:
- To evaluate the diagnostic accuracy of myelography and CT myelography (CTM) for nerve root avulsions in birth palsy.
- To assess the utility of root-somatosensory evoked potential (root-SEP) in conjunction with imaging.
Main Methods:
- Retrospective review of 18 birth palsy cases with suspected avulsion injury.
- Analysis of myelography and CTM findings in 19 affected limbs.
- Correlation of imaging results with root-SEP data in 9 patients undergoing surgery.
Main Results:
- Myelography identified 58 abnormal nerve roots (45 complete, 13 incomplete avulsions).
- Traumatic meningoceles were detected in 79% of roots by myelography and/or CTM.
- CTM excelled at visualizing meningoceles, while myelography was superior for diagnosing avulsions without meningoceles (12 cases).
- Root-SEP was negative in complete avulsions and positive in incomplete avulsions.
Conclusions:
- Myelography remains indispensable for diagnosing nerve root avulsions, particularly when meningoceles are not present.
- CTM is a valuable adjunct for detecting meningoceles but less accurate for avulsion assessment.
- Root-SEP can help differentiate complete from incomplete avulsions.