{ "schema": "injury-atlas-representative-root-level-coverage-v14", "levelSet": [ "C1", "C2", "C3", "C4", "C5", "C6", "C7", "C8", "L1", "L2", "L3", "L4", "L5", "S1" ], "requestedRepresentativeLevelCoverageComplete": true, "representativeLevelCount": 14, "pathologyExamples": 13, "normalReferences": 1, "clinicalCertification": false, "completeDiseaseFamilyCoverage": false, "clinicalInterpretation": { "factualSourceIDs": [ "dermatome-overlap", "radicular-pain-variation", "cervical-variation", "upper-lumbar-variation" ], "policy": "Describe possible patterns and variability; distinguish sensory loss, radicular pain and motor findings. No exact diagnostic dermatome borders, no root diagnosis from symptoms or disc level alone.", "C1": "Often lacks a cutaneous dermatome; a routine skin-territory overlay is inappropriate. Sensory-root and ganglion anatomy varies.", "upperLumbar": "A single disc can affect more than one descending root or conus-related structures; chosen one-root examples must be labelled representative." }, "broaderMechanismCoverage": [ { "mechanism": "Focal disc contact", "status": "ten accepted representative contact examples; nerve shape unchanged", "levels": [ "C3", "C4", "C6", "C7", "C8", "L2", "L3", "L4", "L5", "S1" ], "completeFamily": false }, { "mechanism": "Non-disc upper cervical joint encroachment", "status": "accepted C2 joint-attached osteophyte/root-DRG contact example", "levels": [ "C2" ], "completeFamily": false }, { "mechanism": "Qualitative continuous nerve narrowing/deflection", "status": "accepted original continuous C5 and L1 qualitative examples; no measured pressure or severity", "levels": [ "C5", "L1" ], "pointContactSufficient": false, "clinicalPressureOrSeverityCalibration": false }, { "mechanism": "Root anatomy without invented lesion", "status": "accepted normal-only C1 reference with disclosed sensory variant", "levels": [ "C1" ], "injuredControlApplicable": false }, { "mechanism": "Additional causes and variants", "status": "beyond single representative level coverage", "examples": [ "multilevel disease", "osseous/ligamentous foraminal or recess narrowing", "larger central multiroot or cord/conus involvement", "migration/extrusion/sequestration", "transitional vertebral numbering", "conjoined roots or plexus/rootlet variation", "inflammatory/chemical irritation without a conspicuous contact lesion" ], "allCausesAndVariantsComplete": false } ], "factualSources": [ { "id": "cervical-exit-naming", "title": "Anatomy, Head and Neck: Cervical Nerves", "url": "https://www.ncbi.nlm.nih.gov/books/NBK538136/", "alternate": "https://pubmed.ncbi.nlm.nih.gov/30844163/", "type": "authoritative anatomy reference", "access": "Indexed official source text and PubMed excerpt read; direct Bookshelf request challenged", "supports": "C1–C7 emerge above the same-numbered vertebra; C8 emerges below C7. Root and vertebral numbers are distinct.", "limits": "General reference; not a licence for its dermatome illustrations or patient anatomy." }, { "id": "upper-cervical-no-disc", "title": "Craniocervical junction involvement in inflammatory arthritis: a single-center radiologic study", "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC10760572/", "type": "primary radiologic cohort with anatomical introduction", "access": "Indexed full official text read", "supports": "Occiput–atlas and atlas–axis are synovial-joint anatomy, without intervening discs; atlas ring/lateral masses and axis dens require distinct geometry.", "limits": "Cohort disease frequencies and inflammatory changes are not a template for the proposed C2 osteoarthritis example." }, { "id": "c1-primary-variation", "title": "Classification and clinical anatomy of the first spinal nerve: surgical implications", "url": "https://pubmed.ncbi.nlm.nih.gov/19441999/", "doi": "10.3171/2008.12.SPINE08661", "type": "primary adult cadaveric study", "access": "Indexed official abstract read", "supports": "C1 dorsal roots and ganglia vary; a ventral-only C1 nerve is a documented anatomical variant.", "limits": "Do not infer universal absence of C1 sensory roots, ganglia or all sensory function; no specimen geometry reused." }, { "id": "c1-primary-dorsal", "title": "Clinical anatomy of the C1 dorsal root, ganglion, and ramus: a review and anatomical study", "url": "https://pubmed.ncbi.nlm.nih.gov/17330847/", "doi": "10.1002/ca.20472", "type": "primary adult cadaveric study", "access": "Indexed official abstract read", "supports": "C1 dorsal-root/ganglion presence and spinal-accessory connections vary across specimens.", "limits": "A different cadaver cohort from the 2009 study; percentages are not universal population prevalence." }, { "id": "c1-suboccipital-anatomy", "title": "Neuroanatomy, Suboccipital Nerve", "url": "https://www.ncbi.nlm.nih.gov/books/NBK556133/", "type": "authoritative anatomy reference", "access": "Indexed official full text read; direct request challenged", "supports": "Suboccipital nerve is the C1 dorsal ramus, predominantly motor to suboccipital muscles; its course is above the atlas posterior arch beside vertebral artery context. It does not supply a routine cutaneous dermatome.", "limits": "Root/spinal nerve/dorsal ramus must not be treated as interchangeable; source variants are simplified for an authored reference." }, { "id": "c2-cadaver-corridor", "title": "Anatomic considerations of C2 nerve root ganglion", "url": "https://pubmed.ncbi.nlm.nih.gov/9549785/", "doi": "10.1097/00007632-199803150-00001", "type": "primary cadaveric study", "access": "Indexed official abstract read", "supports": "C2 roots and dorsal-root ganglia occupy the corridor between atlas arch and axis lamina.", "limits": "Study measurements are not patient dimensions or automatic constriction targets." }, { "id": "c2-joint-lesion", "title": "Occipital neuralgia secondary to unilateral atlantoaxial osteoarthritis: Case report and review of the literature", "url": "https://pubmed.ncbi.nlm.nih.gov/26759731/", "doi": "10.4103/2152-7806.172531", "type": "primary clinical case report", "access": "Official PubMed abstract and textual figure descriptions read", "supports": "A posterior C1–C2 lateral-joint osteophyte can encroach upon the C2 root. This supports a non-disc educational mechanism.", "limits": "Single rare clinical case; does not prove that all upper-neck/scalp pain arises from C2 root compression. Images/CT/MRI coordinates not copied." }, { "id": "cervical-variation", "title": "Reliability and Diagnostic Accuracy of Standard Dermatomes and Myotomes for Determining the Pathologic Level in Surgically Verified Patients With Cervical Radiculopathy", "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC9816603/", "doi": "10.14245/ns.2244194.097", "type": "primary retrospective surgically verified cohort", "access": "Official full text read", "supports": "Table 1 maps C4–C5/C5, C5–C6/C6, C6–C7/C7 and C7–T1/C8. Symptoms often depart from conventional dermatomal/myotomal patterns.", "limits": "Selected surgical C5–C8 population; not evidence for upper-cervical prevalence or exact universal borders." }, { "id": "lumbar-exit-traverse", "title": "Lumbar Disc Herniation", "url": "https://www.ncbi.nlm.nih.gov/books/NBK560878/", "type": "authoritative clinical/anatomy reference", "access": "Indexed official clinical/anatomical text read; direct request challenged", "supports": "Lumbar exiting roots lie in the same-numbered caudal foramen; paracentral lesions usually involve the next descending root, whereas foraminal/far-lateral lesions involve the exiting root.", "limits": "A positional rule for standard numbered anatomy, not a diagnosis from disc level alone; transitional/conjoined variants require separate handling." }, { "id": "lumbar-spatial-zones", "title": "Magnetic resonance imaging of the spine", "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC7571515/", "type": "peer-reviewed anatomical imaging reference", "access": "Indexed official spatial-reporting section read; direct request challenged", "supports": "Pedicle and facet margins define central/subarticular/foraminal/extraforaminal locations; L3–L4 recess contains traversing L4 while its foramen contains exiting L3.", "limits": "Spatial definitions guide original review; imaging panels and measured disease dimensions are not assets." }, { "id": "upper-lumbar-variation", "title": "Clinical Features and Treatments of Upper Lumbar Disc Herniations", "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC2941853/", "doi": "10.3340/jkns.2010.48.2.119", "type": "primary retrospective surgical cohort", "access": "Indexed official full text read; direct request challenged", "supports": "L1–L2/L2–L3 clinical presentation can be poorly localized and involve multiple roots or conus-related anatomy.", "limits": "Selected 41-patient surgical cohort; not a deterministic single-root symptom map." }, { "id": "l1-original-case", "title": "L1 Radiculopathy Caused by L1–L2 Extraforaminal Disc Herniation", "url": "https://www.jstage.jst.go.jp/article/ssrr/7/1/7_2022-0107/_pdf/-char/en", "doi": "10.22603/ssrr.2022-0107", "type": "primary clinical case report", "access": "Publisher PDF text read", "supports": "An L1–L2 lateral/extraforaminal lesion can affect L1; reported symptoms crossed simple inguinal-only expectations.", "limits": "The actual case is extraforaminal. Classify an authored candidate by actual pedicle boundaries; do not call a lateral lesion foraminal merely from the root number. No figures/CT data reused." }, { "id": "conus-position-variation", "title": "Conus medullaris termination: Assessing safety of spinal anesthesia in the L2–L3 interspace", "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC11780305/", "type": "primary adult MRI cohort", "access": "Indexed official results and methods read", "supports": "Adult conus termination varies; L1 was common in this 944-patient cohort. A disclosed lower-L1 representative tip is plausible.", "limits": "Do not extend a generic lumbar cord to every disc or infer an individual conus position from population data." }, { "id": "cord-segment-versus-vertebra", "title": "Anatomical relationship and positions of the lumbar and sacral segments of the spinal cord according to the vertebral bodies and the spinal roots", "url": "https://pubmed.ncbi.nlm.nih.gov/23649511/", "doi": "10.1002/ca.22253", "type": "primary adult cadaveric study", "access": "Indexed official abstract read", "supports": "Spinal cord segment/root origins do not equal same-numbered vertebral body levels; lumbar/sacral root courses descend from more cranial origins.", "limits": "Do not attach L2/L3 rootlets to a convenient same-numbered low lumbar cord segment. Cropped proximal origins may be omitted with disclosure." }, { "id": "dermatome-overlap", "title": "An evidence-based approach to human dermatomes", "url": "https://pubmed.ncbi.nlm.nih.gov/18470936/", "doi": "10.1002/ca.20636", "type": "systematic anatomical evidence review", "access": "Official indexed abstract read", "supports": "Published dermatome maps differ, and overlap and individual variability need emphasis.", "limits": "Map is not reproduced, traced, recolored or converted into geometry." }, { "id": "radicular-pain-variation", "title": "Pain patterns and descriptions in patients with radicular pain: Does the pain necessarily follow a specific dermatome?", "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC2753622/", "doi": "10.1186/1746-1340-17-9", "type": "primary retrospective clinical study", "access": "Indexed official full text read", "supports": "Cervical and lumbar radicular pain often fails to follow a conventional dermatome; even the more commonly dermatomal S1 presentation is not universal.", "limits": "Pain distributions are not equivalent to tactile sensory territories and are not definitive diagnostic root assignments." }, { "id": "contact-deviation-compression", "title": "MR image-based grading of lumbar nerve root compromise due to disk herniation: reliability study with surgical correlation", "url": "https://pubmed.ncbi.nlm.nih.gov/14699183/", "doi": "10.1148/radiol.2302021289", "type": "primary MRI reliability/surgical-correlation study", "access": "Official PubMed abstract read", "supports": "Contact, displacement/deviation and compression are distinct observations.", "limits": "A clinical MRI classification is not applied as a numeric grade to a generic illustration. 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