ABSTRACT
PURPOSE: The pathological mechanism of lumbar spinal stenosis is reduced blood flow in nerve roots and degeneration of nerve roots. Exercise and prostaglandin E1 is used for patients with peripheral arterial disease to increase capillary flow around the main artery and improve symptoms; however, the ankle-brachial index (ABI), an estimation of blood flow in the main artery in the leg, does not change after treatment. Lumbar spinal nerve roots contain somatosensory, somatomotor, and unmyelinated autonomic nerves. Improved blood flow by medication with prostaglandin E1 and decompression surgery in these spinal nerve roots may improve the function of nerve fibers innervating muscle, capillary, and main vessels in the lower leg, resulting in an increased ABI. The purpose of the study was to examine whether these treatments can improve ABI. MATERIALS AND METHODS: One hundred and seven patients who received conservative treatment such as exercise and medication (n=56) or surgical treatment (n=51) were included. Low back pain and leg pain scores, walking distance, and ABI were measured before treatment and after 3 months of conservative treatment alone or surgical treatment followed by conservative treatment. RESULTS: Low back pain, leg pain, and walking distance significantly improved after both treatments (p<0.05). ABI significantly increased in each group (p<0.05). CONCLUSION: This is the first investigation of changes in ABI after treatment in patients with lumbar spinal stenosis. Improvement of the spinal nerve roots by medication and decompression surgery may improve the supply of blood flow to the lower leg in patients with lumbar spinal stenosis.
Subject(s)
Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Alprostadil/therapeutic use , Ankle Brachial Index , Decompression, Surgical/methods , Low Back Pain/drug therapy , Lumbar Vertebrae/physiopathology , Pain/surgery , Spinal Nerve Roots/physiopathology , Spinal Stenosis/physiopathology , Treatment OutcomeABSTRACT
OBJECTIVE@#To evaluate the diagnostic value of somatosensory evoked potential(SEP) in lumbosacral disc herniation(LDH).@*METHODS@#Posterior tibial nerve somatosensory evoked potential(PTNSEP) and dermatomal somatosensory evoked potential (DSEP) were recorded from 60 patients with radiculopathy caused by LDH and 30 healthy subjects.@*RESULTS@#DSEP was abnormal in 56 cases (93.3%) and PTNSEP was abnormal in 26 cases (43.3%). The significant difference was observed (P<0.001). The abnormality of DSEP from L4 dermatome was detected mainly in patients with L3-4 LDH, the abnormality of DSEP from L5 dermatome was detected mainly in patients with L4-5 LDH, the abnormality of DSEP from L5S1 dermatome was detected mainly in patients with S1 LDH. DSEP can reflect the compressed extent of nerve root.@*CONCLUSIONS@#There was a good correlation of DSEP with lumbosacral nerve root injury,which supplement the information that can not be provided by imaging examingation. DSEP is a sensitive electrophysic method that not only is used to evaluate single nerve root function, but also is helpful in the location of the lesion.
Subject(s)
Adult , Female , Humans , Male , Middle Aged , Electric Stimulation , Electrodiagnosis/methods , Evoked Potentials, Somatosensory , Forensic Medicine , Intervertebral Disc Displacement/physiopathology , Lumbar Vertebrae , Magnetic Resonance Imaging , Sensitivity and Specificity , Spinal Nerve Roots/physiopathology , Tibial Nerve/physiologyABSTRACT
Peripheral nerve injury frequently leads to neuropathic pain like hyperalgesia, spontaneous pain, mechanical allodynia, thermal allodynia. It is uncertain where the neuropathic pain originates and how it is transmitted to the central nervous system. This study was performed in order to determine which peripheral component may lead to the symptoms of neuropathic pain. Under halothane anesthesia, male Sprague-Dawley rats were subjected to neuropathic surgery by tightly ligating and cutting the tibial and sural nerves and leaving the common peroneal nerve intact. Behavioral tests for mechanical allodynia, thermal allodynia, and spontaneous pain were performed for 2 weeks postoperatively. Subsequently, second operation was performed as follows: in experiment 1, the neuroma was removed; in experiment 2, the dorsal roots of the L4-L6 spinal segments were cut; in experiment 3, the dorsal roots of the L2-L6 spinal segments were cut. Behavioral tests were performed for 4 weeks after the second operation. Following the removal of the neuroma, neuropathic pain remained in experiment 1. After the cutting of the L4-L6 or L2-L6 dorsal roots, neuropathic pain was reduced in experiments 2 and 3. The most remarkable relief was seen after the cutting of the L2-L6 dorsal roots in experiment 3. According to the fact that the sciatic nerve is composed of the L4-L6 spinal nerves and the femoral nerve is composed of the L2-L4 spinal nerves, neuropathic pain is transmitted to the central nervous system via not only the injured nerves but also adjacent intact nerves. These results also suggest that the dorsal root ganglion is very important in the development of neuropathic pain syndrome.
Subject(s)
Male , Rats , Animals , Ganglia, Spinal/physiopathology , Nervous System Diseases/physiopathology , Nervous System Diseases/complications , Pain/physiopathology , Pain/etiology , Rats, Sprague-Dawley , Spinal Nerve Roots/physiopathology , Spinal Nerves/physiopathologyABSTRACT
A produçäo de cefaléias a partir de anormalidades no pescoço nunca foi sistematizada a ponto de permitir o estudo de sua patogenia, embora fosse fato conhecido há muitos anos. Sjaastad et al. descreveram, em 1983, grupo de pacientes com uma cefaléia uniforme e estereotipada. Os ataques se caracterizam por dor moderada, unilateral sem mudança de lado, de longa duraçäo, recorrendo em poucas semanas. A cefaléia podia ser provocada por certos movimentos do prescoço ou por commpressäo de pontos desencadeadores ali localizados. A dor se iniciava na regiäo cervical, irradiando-se para as áreas órbito-fronto-temporal e/ou facial. A denominaçäo "cefaléia cervicogênica" (CC) foi proposta para esta entidade. Sua fisiopatogenia näo é completamente conhecida. Bloqueios da raiz C2 e do nervo grande occipital eliminam a dor. Apresentamos um caso de CC, fazendo alguns comentários acerca do seu quadro clínico, fisiopatologia e tratamento
Subject(s)
Humans , Adult , Female , Cervical Vertebrae/physiopathology , Headache/etiology , Cervical Vertebrae/innervation , Diagnosis, Differential , Headache/diagnosis , Headache/surgery , Migraine Disorders/diagnosis , Movement/physiology , Nerve Block , Nerve Compression Syndromes/diagnosis , Sex Factors , Spinal Nerve Roots/physiopathologyABSTRACT
El reflejo H es un reflejo monosinaptico evocado por la estimulación elétrica de fibras aferentes de gran calibre pertenecientes a un nervio mixto que hacen sinapsis con motoneuronas alfa a nivel medular. Existen numerosas publicaciones (2, 3, 4, 6, 7, 9) que sugieren la aplicación clínica mediante registro en músculo gastrocnemio después de la estimulación del nervio tibial en la fosa poplitea (5) ha sido descrito como útil en la lesión a nivel de raiz Sl. Uno de los propósitos de nuestro trabajo consistió en comprobar la utilidad de esta técnica de conducción nerviosa en pacientes del Hospital Ortopédico "Frank Pais" con diagnóstico clínico de Síndrome de Compresión Radicular (SCR) a nível de Sl. De manera similar quisimos conocer si es posíble diferenciar a pacientes con críterio clínico de SCR Sl de aquellos con posíble compresión de L5, ya que ambos son raices vecinas con gran incidencia de afectación en la práctica médica