Axon Count and Sympathetic Skin Responses in Lumbosacral Radiculopathy

Hacer Erdem Tilki,Melek Coşkun,Neslihan Ünal Akdemir,Lütfi İncesu 대한신경과학회 2014 Journal of Clinical Neurology Vol.10 No.1

Background and Purpose Electrodiagnostic studies can be used to confirm the diagnosis oflumbosacral radiculopathies, but more sensitive diagnostic methods are often needed to measure the ensuing motor neuronal loss and sympathetic failure. Methods Twenty-six patients with lumbar radiculopathy and 30 controls were investigatedusing nerve conduction studies, motor unit number estimation (MUNE), testing of the sympathetic skin response (SSR), quantitative electromyography (QEMG), and magnetic resonancemyelography (MRM). Results Using QEMG as the gold standard, the sensitivity and specificity of MUNE for the abductor hallucis longus muscle were 71.4% and 70%, respectively. While they were 75% and 68.8%, respectively, when used MRM as gold standard. The sensitivity and specificity ofMUNE for the extensor digitorum brevis muscle were 100% and 84.1%, respectively, when theperoneal motor amplitude as the gold standard. The SSR latency was slightly longer in the patients than in the controls. Conclusions MUNE is a simple and sensitive test for evaluating autonomic function and for diagnosing lumbosacral radiculopathy in patients. MUNE could be used routinely as a guide for the rehabilitation of patients with radiculopathies. SSR measurements may reveal subtle sympathetic abnormalities in patients with lumbosacral radiculopathy.

신경근 병변 환자의 하지 방사통에 대한 선택적 신경근 차단술의 효과

성덕현,이강우,방희제 大韓再活醫學會 1998 Annals of Rehabilitation Medicine Vol.22 No.1

신경근병증에서 전기진단검사의 진료권고안

손민균,최영철,서정환,심동석,권희규 대한근전도전기진단의학회 2012 대한근전도 전기진단의학회지 Vol.14 No.1

The purpose of this study was to provide optimum practical guideline for electrodiagnostic testing of patients with suspected cervical or lumbosacral radiculopathy. For the guideline presented here, PubMed, and KoreaMed searches were performed. When little or no data from well-designed prospective trials were available, an emphasis was placed on the results from large series and reports from expert consensus conference. This guideline contains evidences and recommendations on the each electrodiagnostic testing for the evaluation of radiculopathy: needle EMG, nerve conduction study, H-reflex, F-wave, evoked potential and root stimulation.

요천추 다발성 신경근병증의 소견을 보인 전각세포 병변 2예 - 증례 보고 -

윤형석,권희규,이석준,유승한 대한근전도전기진단의학회 2011 대한근전도 전기진단의학회지 Vol.13 No.2

The osteoporotic compression fracture developed in old age frequently accompanies degenerative change and/or spinal stenosis in lumbar spine. When the patient with compression fracture complains of pain and weakness of lower extremity, an accurate diagnosis of the causative lesion is critical for the treatment. We present two patients who developed pain and weakness of bilateral lower extremities accompanying voiding difficulty after having an operation of T12 vertebroplasty. Radiologic findings of these patients revealed posterior displacement of T12 vertebral body and lumbosacral spinal stenosis. The electrophysiologic findings were compatible with L5, S1 and S2 radiculopathies. We interpreted that these electrophysiologic findings were not caused by the lumbosacral root lesion, but by the involvement of anterior horn cell which contains both lumbar and upper sacral segments at the level of T12 vertebra. One patient was successfully treated with T12 decompressive laminectomy but the other refused to take the surgery.

Preganglionic Epidural Steroid Injection through Translateral Recess Approach

Seok Min Hwang,In Seok Son,Pei Juin Yang,Min Seok Kang 대한정형외과학회 2019 Clinics in Orthopedic Surgery Vol.11 No.1

The approach we suggest was developed for cases in which the fourth and fifth lumbar and first sacral spinal nerves were affected in lumbar degenerative disc disease. Retrodiscal transforaminal epidural injection is known to be very effective for lumbar radiculopathy because of excellent access to primary pathology; however, access below L5 is often restricted by the anatomic characteristics of the L5–S1. In the translateral recess approach (TLR), proper final needle placement (i.e., in the axillary portion between the exiting and traversing nerve roots) can be achieved by setting the direction of the needle laterally and superiorly from the distal tip of the infra-adjacent spinous process toward the medial wall of the pedicle and neural foramen of the given level without neural injury. This approach is possible because of the wide interlaminar space in the L5–S1. Preganglionic epidural injection through TLR is an effective and safe spinal intervention for lumbosacral radiculopathy.

Comparison of Clinical Outcomes of Different Rates of Infusion in Caudal Epidural Steroid Injection: A Randomized Controlled Trial

Thiengwittayaporn Satit,Koompong Punsang,Khamrailert Supat,Wetpiriyakul Pumibal 대한척추외과학회 2021 Asian Spine Journal Vol.15 No.2

Study Design: Prospective randomized controlled equivalence trial.Purpose: To compare the clinical outcomes between patients with lumbosacral radiculopathy that received caudal epidural steroid injection (CESI) at injection rates of 40 mL/min (fast rate) and 20 mL/min (slow rate) and to identify the complications associated with these different CESI rates.Overview of Literature: CESI is widely used for chronic low back pain with lumbar radiculopathy. However, the influence of CESI rates on clinical outcomes has not been well studied.Methods: Ninety patients were randomized into two CESI groups. Two patients did not complete the study. Eighty-eight were included in the final analysis: 44 patients were in the fast infusion group, and 44 patients were in the slow infusion group. Intragroup and intergroup comparisons were conducted with regard to the Visual Analog Scale (VAS), Roland 5-point pain scale, standing tolerance test, walking tolerance test, and patient satisfaction scale at pre-injection, 2 weeks, 6 weeks, and 12 weeks post-injection. Complications associated with the different rates were recorded.Results: Both groups demonstrated clinical improvement in all parameters, except for VAS, after injection. There were no statistically significant differences in any outcomes at each time point between the two groups. One patient in the fast rate group and no patients in the slow rate group experienced nausea and vomiting after injection (<i>p</i> =0.320). Eight patents in the fast rate group and two patients in the slow rate group experienced pain at the injection site (<i>p</i> =0.044).Conclusions: Although there were no significant differences between injection rates in the short-term clinical improvement outcomes, the fast injection rate group experienced more pain at the injection site, suggesting that the use of the slow injection rate may be considered.

요천추신경병증에 대한 심부협척 도침술과 한의통상치료의 효과 비교안전성, 유효성, 경제성평가 : 연구 프로토콜

허인(In Heo),이진현(Jin-Hyun Lee),고연석(Youn-Suk Ko),조동찬(Dong Chan Jo),김영일(Young Il Kim),이상현(Sang-Hyun Lee),황의형(Eui-Hyoung Hwang),박태용(Tae-Yong Park),황만석(Man-Suk Hwang) 척추신경추나의학회 2021 척추신경추나의학회지 Vol.16 No.2

연구 배경 최근 한국 및 중국에서 근골격계 질환에 대한 도침술의 활용이 늘고 있다. 하지만 현재까지의 임상연구는 대부분 증례보고 형태에 그치거나, 충분한 근거가 확보되지는 않은 실정이다. 우리는 요천추신경병증환자의 치료에 있어 도침치료와 통상한의치료와의 비교를 통해 도침치료의 유효성, 안전성, 경제성 평가를 시행하기 위해 본 연구를 기획하게 되었다. 연구 방법 본 연구는 예비임상 연구로, 다기관에서 진행되며, 무작위대조군, 활성 대조군을 통한2개군 병행집단 연구로 평가자 맹검을 시행하게 된다. 이 연구에서는 총 50명의 요천추신경병증환자를 대상으로 2개군으로 균등하게 분배하여 도침술 또는 통상한의치료를 시행하게 된다(각군당 25명). 도침술 그룹의 경우 협척혈에 도침치료를 시행 받게 되며, 통상 한의치료군은 연구자 판단하에 도침술을 제외한 적절한 한의치료를 시행 받게 된다. 두 개의 그룹은 주당 2회씩 총 3주간치료를 받게 된다. 일차 유효성 평가는 요통으로 인한 기능장애를 평가하기 위한 Oswestry disability index를 통해 시행한다. 이차 유효성 평가지표로는 numeric rating scale, European Quality of Life 5-Dimension 5-Level, short-form McGill Pain Questionnaire, Roland- Morris Disability Questionnaire scores를 시행하게 된다. 고찰 본 예비임상연구의 결과는 추후 있을 요천추신경병증에 대한 도침치료 및 한의통상치료 비교효과 연구의 유효성, 경제성평가 본 임상연구를 위한 기초 정보 및 가능성을 확인하고 적절한 대상자수 산정에 도움이 될 것이다. 임상연구 등록정보 Clinical Research Information Service(https://cris.nih.go.kr/)에2021년 5월 30일에등록됨. 연구등록번호 KCT0006043. Abbreviations LSS: lumbar spinal stenosis RCT: randomized controlled trial UKC: usual Korean medicine care PNUKH: Pusan National University Korean Medicine Hospital DKMHDU: Daejeon Korean Medicine Hospital of Daejeon University WUKMMC: Woosuk University Korean Medicine Medical Center IRB: institutional review board NRS: numeric rating scale SOP: standard operating procedure KMD: Korean medicine doctor ODI: Oswestry disability index EQ-5D-5L: European Quality of Life 5-Dimension 5-level SF-MPQ: short-form McGill Pain Questionnaire RMDQ: Roland-Morris Disability Questionnaire PRO: patient-reported outcome ITT: intention-to-treat PP: per-protocol

단일 요천추 신경근증에서 선택적 신경근 차단술의 단기 임상 결과 및 효용성

김상범(Sang-Bum Kim),전택수(Taek-Soo Jeon),박원기(Won-Ki Park),조성권(Sung-Kwun Jo),김용상(Yong-Sang Kim),황철목(Cheol-Mog Hwang) 대한정형외과학회 2009 대한정형외과학회지 Vol.44 No.6

목적: 추간판 탈출증 또는 추간공 협착증에 의한 단일 요추 신경근증에서 선택적 신경근 차단술 후 단기 추시 결과를 분석하여 임상적 유용성을 알아보고자 한다. 대상 및 방법: 단일 분절의 추간판 탈출증 또는 추간공 협착증에 의한 편측 하지 방사통으로 경추간공 스테로이드 주사를 시행받은 환자들 중 65예를 대상으로 후향적 연구를 하였다. 추간판 탈출증 37예를 1군, 추간공 협착증 환자 28예를 2군으로 분류하여 각군에서 Visual analogue scale (VAS)을 이용한 하지 통증의 정도와 주관적인 환자의 만족도로 선택적 신경근 차단술의 치료 효과를 판정하였다. 평균 추시 기간은 11개월로 1군은 13.5개월, 2군은 7.6개월이었다. 결과: 총 65명의 환자들의 시술 전 VAS는 평균 7.8에서 1-3회의 신경근 차단술 후 1개월 째 2.9, 3개월 째 3.4로 감소하였다. 1군의 경우 시술 전 VAS는 7.4에서 시술 후 1개월에 3.3, 3개월에 3.7로 통증이 감소하였고, 2군의 경우 VAS는 시술 전 평균 8.3에서 시술 후 1개월 평균 2.3, 3개월 평균 3.0으로 호전되었다. 시술의 효과가 없거나 시술 후 증상이 악화 되어 수술을 시행한 경우는 1군에서 8예(12%), 2군에서 4예(6%)가 있었으며 1개월 추시에서 증상의 호전이 있었으나 3개월 추시에서 악화된 경우는 1군의 경우 3예(8%) 2군의 경우 2예 (7%)를 보였다. 두 군 중 추간공 협착증의 경우가 1개월(p=0.002) 및 3개월(p=0.01) 추시에서 더 나은 치료 결과를 보였다. 두 군 모두에서 선택적 신경근 차단술과 관련된 합병증은 발생하지 않았다. 결론: 요추 추간판 탈출증 또는 추간공 협착증에 의한 단일 신경근증으로 인한 편측성 하지 방사통의 비수술적 치료로서 증상 발현 후 초기 단계에서의 선택적 신경근 차단술은 매우 효과적이고 안전한 시술이다. 따라서 수술적 치료를 선택하기 이전에 반드시 시행을 고려하는 것이 바람직할 것으로 사료되며, 특히 추간공 협착증의 경우 더욱 효과적일 것으로 사료된다. Purpose: We wanted to determine the clinic usefulness of selective nerve root block for treating lumbosacral radiculopathy that's due to a herniated nucleus pulposus (HNP) or foraminal stenosis (FS) by analyzing the short-term results after the selective nerve root block (SNRB) procedure. Materials and Methods: Sixty-five patients were investigated in our research. Sixty-five patients were divided into two groups: thirty-seven patients of group one were the HNP patients and twenty-eight patients of group two were the FS patients. The effect of SNRB treatment was assessed by the degree of radiating pain in lower legs with using the visual analogue scale (VAS) and patients' subjective satisfaction. The average overall follow-up period was eleven months: that of the first group was 13.5 months and that of the group was 7.6 months. Results: For the 65 patients, the average VAS was 7.8 before a SNRB procedure and this decreased to 2.9 and 3.4 after one to three SNRB procedures, respectively. For group one, the VAS was 7.4 before the procedure and it decreased to 3.3 at one month and 3.7 at three months after the procedure. For group two, the VAS was 8.3 before the SNRB procedure and this favorably changed to 2.3 at one month and 3.0 at three months after the procedure. An operation was carried out due to no response for 8 patients (12%) and due to aggravation for 4 patients (6%) after the SNRB procedures. Three patients (8%) of group one and two patients (11 %) of group two obtained pain relief at one month and aggravation at three months, respectively. On comparing the two groups, a better treatment effect was observed for the FS group after one month (p=0.002) and three months (p=0.01). Complications related to the SNRB procedure haaves not been observed in both groups. Conclusion: The SNRB procedure is a very effective and safe procedure, after the appearance of symptoms, as a non-operative treatment for single lumbosacral radiculopathy due to a herniated nucleus pulposus or foraminal stenosis. This treatment appears to be more effective for the FS group than for the HNP group and it should be considered before carrying out an operative treatment.

Treatment of Lumbosacral Radiculopathy with Acupuncture and Medical Herbs: Four Case Reports

채한,오유나,최지원,안광수,Yeon Hak Kim,Jun-Hwan Lee,김은석,이병렬,양기영 사단법인약침학회 2022 Journal of Acupuncture & Meridian Studies Vol.15 No.4

Lumbosacral radiculopathy (LR) is a musculoskeletal disorder or pain syndrome that is generally linked to the compression or irritation of the nerve root. There is a growing interest in the development of efficient acupuncture-based treatments for LR comparable to western medicine. Structured traditional Korean medical treatments including intensified acupuncture stimulus on the EX-B2 point using the G-shaped posture modified from the sitting posture were applied to four LR patients, and the outcomes were evaluated based on objective clinical endpoints including a numeric rating scale (NRS), the Oswestry disability index (ODI), the manual muscle test (MMT), neurological symptoms, and plantar photography. Patients showed improvements in NRS, ODI, MMT, and neurological symptoms without adverse effects during hospitalization and follow-up visits. Moreover, we observed substantial dissolvement of hyperkeratinization and parchedness of the soles of the feet, which was not reported previously. These four cases demonstrate the clinical usefulness of traditional medicine and the diagnostic applicability of plantar photography. However, further randomized controlled trials are required to confirm our findings.

Minimally Invasive Transtubular Endoscopic Decompression for L5 Radiculopathy Induced by Lumbosacral Extraforaminal Lesions

Ko Ikuta,Takahiro Kitamura,Keigo Masuda,Kensuke Hotta,Hideyuki Senba,Satoshi Shidahara 대한척추외과학회 2018 Asian Spine Journal Vol.12 No.2

Study Design: Retrospective study. Purpose: This study aimed to evaluate the efficacy of minimally invasive transtubular endoscopic decompression for the treatment of lumbosacral extraforaminal lesion (LSEFL). Overview of Literature: Conventional procedures for surgical decompression for the treatment of LSEFL involve certain technical challenges because the lumbosacral extraforaminal region has unique anatomical features. Moreover, the efficacy of minimally invasive procedures performed via the posterolateral approach for LSEFL has been reported. Methods: Twenty-five patients who had undergone minimally invasive transtubular endoscopic decompression for the treatment of LSEFL and could be followed up for at least 1 year postoperatively were enrolled. Five of these patients had a history of lumbar surgery, and seven had concomitant adjacent-level spinal stenosis. The clinical outcomes were evaluated using the Japanese Orthopaedic Association (JOA) lumbar score, numeric rating scale (NRS), and the JOA Back Pain Evaluation Questionnaire (JOABPEQ). The mean postoperative follow-up (FU) duration was 3.8 years. Results: All procedures could be completed without any severe surgical complications, and all patients could resume their previous activity level within 1 month postoperatively. The JOA score significantly increased from 14.1±4.0 at baseline to 23.1±3.7 at the 1-year FU and 22.1±3.8 at the last FU. Similarly, there were significant improvements in the postoperative NRS and JOABPEQ scores. An additional surgery was performed in two patients (8%) during the FU period. Patients with degenerative scoliosis exhibited significantly poorer outcomes compared with those without this condition. Conclusions: Transtubular endoscopic decompression can overcome certain technical challenges involved in the conventional procedures for LSEFL treatment; therefore, it can be recommended as a useful procedure for treating LSEFL. This procedure can provide some benefits to LSEFL patients and offer a well-illuminated surgical field and high surgical safety for the surgeon. However, the procedure should be carefully adapted for LSEFL patients with concomitant degenerative scoliosis.