Proximal Conduction Time Along The Lumbar Plexus

Lomber pleksus'un proksimal iletim zamanının değerlendirilmesi, klinik nörofizyolojininönemli sorunlarından birisidir. Bu çalışmada, genellikle yapıldığı gibi, lomber pleksusunsadece distal parçasını araştırmak yerine, hem distal hem proksimal parçasını araştırmayıamaçladık. Bu çalışmada 109 sağlıklı erişkin olguda, periferik elektrik uyarım ve lombermanyetik uyarımla genitofemoral, obturator ve femoral sinirin motor iletim zamanı ölçülerek,ayrıca adduktor ve kuadriseps kas grubunda H refleksi metodu kullanarak farklı proksimal ileti metotları çalışıldı. Çalışmanın anatomik kısmı 20 yetişkin kadavrada femoral, obturator,genitofemoral sinir ve proksimal kökler diseke edilerek uygulandı. Ligamentum inguinale'denspinal seviyeye ortalama toplam mesafe femoral sinirde 392.4±13.3mm, obturator sinirdeyaklaşık olarak 382.8±11.1, genitofemoral sinirde ise 353.1±12.5mm olarak ölçüldü. H-refleksi metodu ile, kadavradan elde edilen mesafe kullanılarak femoral ve obturator sinirinproksimal iletim zamanı 62.5±6.1 ve 53.6±7.4 m/sn olarak saptandı. Periferik elektrik uyarımve lomber manyetik uyarım ile femoral, obturator ve genitofemoral sinirin proksimal ileti hızısırası ile 59.1±13.3, 52.7±14.9, 58.7±0.8 m/sn olarak ölçüldü. Her iki metotla da proksimalileti hızları arasında istatistiksel olarak farklılık gözlenmedi. Her iki yaklaşım da olgulara göreproksimal ileti hızını değerlendirmek için tercih edilebilir.

Anahtar Kelime:

Konular: Nörolojik Bilimler

Lomber Pleksus Proksimal İletim Zamanı

Öz:

Scientific Background: One of the matters in clinical neurophysiology is evaluation of theproximal conduction time along the lumbar plexus. Objectives: Instead of investigating onlydistal segment of the nerve from the groin as is generally done we aimed to investigate bothproximal and distal parts of the nerves originating from the lumbar plexus.Material and Methods: In this paper different proximal conduction methods were studied in109 healthy adult human subjects by measuring proximal motor conduction time of femoral,obturator and genitofemoral nerve along the lumbar plexus using both by using lumbarmagnetic and peripheral electrical stimulation and by using the H-reflex methods in adductorand quadriceps muscle group. The anatomical parts of the study were applied on 20 humanadult cadavers, dissecting femoral, obturator genitofemoral nerve and roots proximally.Results: The total distance from ligamentum inguinale to spinal level was 392.4±13.3mm infemoral nerve. The total distance was approximately 382.8±11.1mm in obturator nerve andthe total distance was approximately 353.1±12.5 mm in genitofemoral nerve. With the Hreflex method, using the distance obtained from the cadaver, femoral and obturator nerveproximal conduction velocity were determined to be 62.5±6.1 m/sec and 53.6±7.4 m/sec,respectively. Using lumbar magnetic stimulation and the peripheral electrical stimulation,proximal conduction velocities in femoral, obturator and genitofemoral nerves weredetermined to be 59.1±13.3m/sec, 52.7±14.9 and 58.7±0.8 m/sec, respectively.Conclusions: No statistical differences were found between the proximal conductionvelocities elicited by both methods. Either approach is preferable to evaluate proximalconduction time.

Anahtar Kelime:

Konular: Nörolojik Bilimler

Belge Türü: Makale Makale Türü: Araştırma Makalesi Erişim Türü: Erişime Açık

1. Aiello I, Serra G, Rosati G, Tugnoli V. A. Quantitative method to analyse the H-ref lex latencies f rom vastus medialis muscle: normal values. Electromyogr Clin Neurop hysiol 1982; 22:251-254.
2. Alf onsi E, MerloIM, Clerici AM, Candeloro E, Marchioni E, Moglia A. p roximal nerve conduction by high voltage electrical stimulation in S1 radiculop athies and acquired demyelinating neurop athies. Clin Neurop hysiol 2003; 114(2) :239- 247.
3. Arowayeh HN, sabbahi MA. Vastus medialis H ref lex reliability during standing. J Clin neurop hysiol. 2006; 23(1) :79-84.
4. Britton TC, Meyer B U, Hardmann J, et al. Clinical use of the Magnetic stimulation in the investigation of p erip heral conduction time. Muscle Nerve 1990; 13: 396-406.
5. Carls G, Ziemann U, Kunkel M, Reimers CD. Electrical and magnetic stimulation of the intercostal nerves: a comp arative study. Electroencep halogr Clin Neurop hysiol. 1997; 32(8) : 509-512.
6. Chokroverty S, Deutsch A, Guha C, Gonzales A, Kwan P, Burger R, Goldberg J. Thoracic sp inal nerve and root conduction: a magnetic stimulation study. Muscle Nerve 1995;18(9) :987-991.
7. Chop ra JS, Hurwitz LJ. Femoral nerve conduction in diabetes and chronic occlusive vascular disease. J of Neurol Neurosurg Psychiatry 1968; 31:28-33
8. Cranberg L. Femoral neurop athy f rom iliac hematoma: Rep ort of a case. Neurology 1979; 29: 1071-1072.
9. Dyck PJB, Norell JE, Dyck PJ. Non-diabetic lumbosacral radiculop lexus neurop athy. Natural history, outcome and comp arison with the diabetic variety. Brain 2001; 124:1197-1207.
10. Dyck PJB and Windebank AJ. Diabetic and nondiabetic lumbosacral radiculop lexus neurop athies: New insights into p athop hysiology and treatment. Muscle Nerve 2002; 25: 477-491.
11. 23a. Ertekin C, Nej at RS, Şirin H, et al. Comp arison of magnetic coil and needle- electrical stimulation in diagnosis of lumbosacral radiculop athy. Muscle Nerve 1994; 17: 685-686.
12. 23b. Ertekin C, Nej at RS, Koyuncuoglu HR, et al. Diagnostic value value of electrical stimulation of lumbosacral roots in radiculop athies. Acta Neurol Scand 1994;90:26-33
13. Ertekin C, Bademkiran F, Yildiz N, Ozdedeli K, Altay B, Aydogdu I, Uludag B. Central and p erip heral motor conduction to cremasteric muscle. Muscle Nerve. 2005; 31(3) :349-354.
14. Ertekin C, Bademkiran F, Tataroglu C, Aydogdu I, Karapınar N. Adductor T and H ref lex in Humans. Muscle Nerve. 2006; 34: 640-645.
15. Gassel MM. A study of f emoral nerve conduction time. Arch Neurol 1963; 9:607-614.
16. Guiheneuc P and Bathien N. Two p atterns of results in p olyneurop athies investigated with the ref lex. Journal of the Neurological Sciences 1976; 30: 83- 94.
17. Hopkins JT, Wagie NC. Intrasession and intersession reliability of the quadriceps Hoff man Ref lex. Electromyogr Clin Neurop hysiol. 2003; 43(2) : 85-89.
18. Johnson E W, Wood PK, Powers JJ. Femoral nerve conduction studies. Arch. Phys. Med. Rehabil 1968; 49: 528-532.
19. Jusic A, Baraba R, Bogunovic A. H ref lex and F wave p otentials in leg and arm muscles. Electromyogr. Clin. Neurop hysiol 1995; 35: 471- 478.
20. Kameyama O, Hayes KC, Wolf e D. Methodological considerations contributing to variability of the quadriceps H-Ref lex. Am. J. Phys Med and Rehabil 1989; 68 : 277-282.
21. Maccabee PJ, Amassian VE, Cracco RQ, Cracco JB, Eberle L, Rudell A. stimulation of the human nervous system using magnetic coil. J Clin Neurop hysiol. 1991; 8(1) : 38-55.
22. Maccabee PJ, Lip itz ME, Desudchit T et al. A new method using neuromagnetic stimulation to measure conduction time with in the cauda equine. Electromyogr. Clin. Neurop hysiol. 1996; 101(2) :153-166.
23. MacDonnell RAL, Cros D, Shahani BT. Lumbosacral nerve stimulation comp aring electrical with surf ace magnetic coil technique. Muscle Nerve 1992; 15: 885-890.
24. Maertens de Noordhout CD, Rothwell JC, Thompson PD, et al. Percutaneus electrical stimulationof lumbosacral roots in man. J of Neurol Neurosurg Psychiatry 1988; 51: 174-181.
25. Reinstein L, Alevizatos AC, Twardzik FG, et. al. Femoral nerve dysf unction af ter retrop eritoneal hemorrhage: Pathop hysiology revealed by comp uted tomograp hy. Arch Phys Med Rehabil 1984; 65: 37- 40.
26. Rossini PM, Barker AT, Berardelli A, et al. Noninvasive electrical and magnetic stimulation of the brain, sp inal cord, and roots: basic p rincip les and p rocedures f or routine clinical app lication. Electroencep halgr Clin Neurop hysiol 1994; 91: 79- 92.
27. Sorenson EJ, Chen JJ, Daube JR. Obturator Neurop athy : Causes and Outcome. Muscle Nerve 2002; 25:605-607.
28. Subramony SH, Wilbourn AJ: Diabetic p roximal neurop athy; Clinical and electrodiagnostic f eatures. J.Neurol Sci 1982; 53. 293-304.
29. Tabaraud F, Hugon J, Chazot F, Moreau JJ, Vallat JM, Dumas M. Motor evoked resp onses af ter lumbar sp inal stimulation in p atients with L5 or S1 radicular involvement. Electroencep halogr Clin Neurop hysiol 1989; 72(4) : 334-339.
30. Tanino T, Takasaki K, Daikuya S, Suzuki T. Introduction of the Vastus Medialis oblique H-ref lex during traction of the leg. Electromyogr. Clin. Neurop hysiol 2007; 47(7-8) : 369-372.
31. Ugawa Y, Rothwell JC, Day BL, et al. Magnetic stimulation over the sp inal enlargements. J of Neurol Neurosurg Psychiatry 1989; 52:1025-1032.
32. Uludag B, Ertekin C, Turman B, Demir D, Kiylioglu N. Proximal and distal motor nerve conduction in obturator and f emoral nerves. Arch Phys Med Rehabil 2000; 81:1166-1170.
33. Verhagen WIM, Schrooten GJM, Schip hof PR, et al. The H-ref lex of the medial vastus muscle: a study in controls and p atients with radiculop athy. Electromyogr Clin Neurop hysiol 1988; 28:421-425.
34. Young MR, Norris J W. Femoral neurop athy during the anticoagulant therapy. Neurology 1976; 26: 1173-1175.

APA	UYSAL H, BADEMKIRAN F, ALBAYRAK N, Esmer A, KELEŞ ÇELİK N, sindel m, TEKDEMİR İ, KIZILAY F, ERTEKİN C (2012). Proximal Conduction Time Along The Lumbar Plexus. , 18 - 31.
Chicago	UYSAL Hilmi,BADEMKIRAN Fikret,ALBAYRAK Nural,Esmer Ali Firat,KELEŞ ÇELİK NİGAR,sindel muzaffer,TEKDEMİR İbrahim,KIZILAY Ferah,ERTEKİN Cumhur Proximal Conduction Time Along The Lumbar Plexus. (2012): 18 - 31.
MLA	UYSAL Hilmi,BADEMKIRAN Fikret,ALBAYRAK Nural,Esmer Ali Firat,KELEŞ ÇELİK NİGAR,sindel muzaffer,TEKDEMİR İbrahim,KIZILAY Ferah,ERTEKİN Cumhur Proximal Conduction Time Along The Lumbar Plexus. , 2012, ss.18 - 31.
AMA	UYSAL H,BADEMKIRAN F,ALBAYRAK N,Esmer A,KELEŞ ÇELİK N,sindel m,TEKDEMİR İ,KIZILAY F,ERTEKİN C Proximal Conduction Time Along The Lumbar Plexus. . 2012; 18 - 31.
Vancouver	UYSAL H,BADEMKIRAN F,ALBAYRAK N,Esmer A,KELEŞ ÇELİK N,sindel m,TEKDEMİR İ,KIZILAY F,ERTEKİN C Proximal Conduction Time Along The Lumbar Plexus. . 2012; 18 - 31.
IEEE	UYSAL H,BADEMKIRAN F,ALBAYRAK N,Esmer A,KELEŞ ÇELİK N,sindel m,TEKDEMİR İ,KIZILAY F,ERTEKİN C "Proximal Conduction Time Along The Lumbar Plexus." , ss.18 - 31, 2012.
ISNAD	UYSAL, Hilmi vd. "Proximal Conduction Time Along The Lumbar Plexus". (2012), 18-31.

APA	UYSAL H, BADEMKIRAN F, ALBAYRAK N, Esmer A, KELEŞ ÇELİK N, sindel m, TEKDEMİR İ, KIZILAY F, ERTEKİN C (2012). Proximal Conduction Time Along The Lumbar Plexus. Journal of Neurological Sciences (Turkish), 29(1), 18 - 31.
Chicago	UYSAL Hilmi,BADEMKIRAN Fikret,ALBAYRAK Nural,Esmer Ali Firat,KELEŞ ÇELİK NİGAR,sindel muzaffer,TEKDEMİR İbrahim,KIZILAY Ferah,ERTEKİN Cumhur Proximal Conduction Time Along The Lumbar Plexus. Journal of Neurological Sciences (Turkish) 29, no.1 (2012): 18 - 31.
MLA	UYSAL Hilmi,BADEMKIRAN Fikret,ALBAYRAK Nural,Esmer Ali Firat,KELEŞ ÇELİK NİGAR,sindel muzaffer,TEKDEMİR İbrahim,KIZILAY Ferah,ERTEKİN Cumhur Proximal Conduction Time Along The Lumbar Plexus. Journal of Neurological Sciences (Turkish), vol.29, no.1, 2012, ss.18 - 31.
AMA	UYSAL H,BADEMKIRAN F,ALBAYRAK N,Esmer A,KELEŞ ÇELİK N,sindel m,TEKDEMİR İ,KIZILAY F,ERTEKİN C Proximal Conduction Time Along The Lumbar Plexus. Journal of Neurological Sciences (Turkish). 2012; 29(1): 18 - 31.
Vancouver	UYSAL H,BADEMKIRAN F,ALBAYRAK N,Esmer A,KELEŞ ÇELİK N,sindel m,TEKDEMİR İ,KIZILAY F,ERTEKİN C Proximal Conduction Time Along The Lumbar Plexus. Journal of Neurological Sciences (Turkish). 2012; 29(1): 18 - 31.
IEEE	UYSAL H,BADEMKIRAN F,ALBAYRAK N,Esmer A,KELEŞ ÇELİK N,sindel m,TEKDEMİR İ,KIZILAY F,ERTEKİN C "Proximal Conduction Time Along The Lumbar Plexus." Journal of Neurological Sciences (Turkish), 29, ss.18 - 31, 2012.
ISNAD	UYSAL, Hilmi vd. "Proximal Conduction Time Along The Lumbar Plexus". Journal of Neurological Sciences (Turkish) 29/1 (2012), 18-31.