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DETERMINATION OF THE SEGMENTAL SENSORY AND MOTOR INNERVATION OF THE LUMBOSACRAL SPINAL NERVES: AN ELECTROPHYSIOLOGICAL STUDY

ROCCO LIGUORI, CHRISTIAN KRARUP, WERNER TROJABORG
DOI: http://dx.doi.org/10.1093/brain/115.3.915 915-934 First published online: 1 June 1992

Summary

The knowledge of the segmental innervation of the skin and muscles of the lower limb in man is inadequate. For this reason, sensory and motor segmental innervation of the lower extremities was examined by electro-physiological methods in 27 normal subjects, one patient with possible L5 radiculopathy and one with possible lumbosacral plexus affection. Needle electrodes were placed at root levels from L3 to S2 using bony landmarks. The electrode was then placed close to the spinal nerve as indicated by a low (⩽ 1 mA) threshold necessary to stimulate motor fibres. The position was controlled by X-ray in 10 subjects.

Sensory innervation was determined by recording the sensory action potential evoked by stimulating the saphenous nerve at the medial epicondyle (mainly L3 and L4) and at the medial malleolus (mainly L4 and in some L3), the medial plantar nerve at the first plantar interstice (mainly S1, some L5 and S2), the deep personeal nerve at the first dorsal interstice (mainly L5, some S1), the sural nerve at the dorsolateral aspect of the foot (mainly S1, some L5 and S2) and at the lateral malleolus (mainly S1, some L5 and S2), and the superficial peroneal nerve at the superior extensor retinaculum (mainly L5, S1). The motor innervation was determined by stimulating the spinal nerves supramaximally and recording the evoked responses from the medial and lateral vastus (mainly L3, L4), the anterior tibial (mainly L5), the peroneus longus (L5, S1), the extensor digitorum brevis (mainly S1), the gastrocnemius (mainly S1), the abductor hallucis (mainly S2) and the biceps femoris (mainly L5, S1).

Sensory and motor conduction velocity measurements along the leg and across the lumbosacral plexus indicated that there was no difference in a disto-proximal direction, except for a 10% reduction along the most distal part of the sural nerve which, however, might be explained by utilization time. There was therefore no evidence of gradual tapering of nerve fibres in a distal direction. The proximal motor conduction velocity to the most distally placed muscle (abductor hallucis) was about 20% lower than to the proximally placed muscles (gastrocnemius and biceps femoris) suggesting a general difference in fibre calibre.