A Critical Appraisal of the Evidence for Selective Nerve Root Injection in the Treatment of Lumbosacral Radiculopathy

ABSTRACT We present an unusual case of a spinal dural arteriovenous malformation (AVM) which produced compression radiculopathy of the left S1 nerve root. The nerve root was compressed by epidural vessels, draining vessels, and the nidus, without the characteristic myelographic findings of a dural AVM. No feeding vessels could be identified. It is important to consider the possibility of a spinal dural AVM in middle-aged patients who suffer lumbosacral radiculopathy, even if myelography does not demonstrate the characteristic findings.

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Correlation between Findings in Physical Examination, Magnetic Resonance Imaging, and Nerve Conduction Studies in Lumbosacral Radiculopathy Caused by Lumbar Intervertebral Disc Herniation

Advances in Orthopedics ◽

10.1155/2020/9719813 ◽

2020 ◽

Vol 2020 ◽

pp. 1-6

Author(s):

Safa Yousif ◽

Afraa Musa ◽

Ammar Ahmed ◽

Ahmed Abdelhai

Keyword(s):

Intervertebral Disc ◽

Physical Examination ◽

Nerve Root ◽

Nerve Conduction Studies ◽

Intervertebral Disc Herniation ◽

Nerve Root Compression ◽

Resonance Imaging ◽

Lumbar Intervertebral Disc ◽

Lumbosacral Radiculopathy ◽

Lumbar Intervertebral Disc Herniation

Purpose. The aim of this study was to find out the correlation between magnetic resonance imaging (MRI) and nerve conduction studies’ (NCS) findings in patients with lumbosacral radiculopathy caused by lumbar intervertebral disc herniation. In addition, the study aimed at finding the correlation between the clinical manifestations of lumbosacral radiculopathy and both MRI and NCS. Patients and Methods. The study was a cross-sectional analytic study which included thirty patients with a history suggestive of lumbosacral radiculopathy. Inclusion criteria were as follows: patients who had an MRI confirmed L4/5 and/or L5/S1 intervertebral disc prolapse in addition to one or more of the following (dermatomal distribution of symptoms appropriate with MRI level, presence of motor weakness, sensory impairment, absent ankle jerk, or positive straight leg raising test). All patients underwent clinical assessment and NCS, and their MRI examination was reviewed. The Chi-Squared/Fisher’s exact test was used to test the correlation. Results. There was a statistically significant correlation between abnormal physical findings and nerve root compression in MRI. Statistically significant correlation was neither found between abnormal physical examination findings and abnormal NCS nor between nerve root compression in MRI and abnormal NCS findings. Conclusion. Abnormal neurological examination findings can be used to predict nerve root compression in MRI examination. On the contrary, positive findings of physical examination do not predict abnormal NCS, as well as negative findings do not exclude abnormal NCS; therefore, it is useful to add NCS when MRI findings do not match clinical examination findings or when no neuroimaging abnormalities can be identified.

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Correlation Between Clinical And Magnetic Resonance Imaging Findings In Patients With Lumbosacral Radiculopathy

TAJ Journal of Teachers Association ◽

10.3329/taj.v28i1.39067 ◽

2018 ◽

Vol 28 (1) ◽

pp. 32-39

Author(s):

Mukul Kumar Sarkar ◽

Pijush Kumar Kundu ◽

Md Munzur Alahi ◽

Md Pervez Amin ◽

Achinta Kumar Mallick ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Low Back Pain ◽

Back Pain ◽

Magnetic Resonance ◽

Intervertebral Disc ◽

Nerve Root ◽

P Value ◽

Low Back ◽

Resonance Imaging ◽

Lumbosacral Radiculopathy

Low back pain accounts for a large amount of loss of productivity in the workforce. When the low back pain extends into the lower limb along the distribution of a dermatome then radiculopathy is said to be present. Although most people experience back pain during their lifetime, only a fraction experience lumbosacral radiculopathy as a consequence of nerve root compression or irritation. Almost 5% males and 2.5% females experience lumbosacral radiculopathy at some time in their lifetime. Magnetic resonance imaging (MRI) is the preferred investigation for the diagnosis of lumbosacral radiculopathy. So, in the evaluation of a patient of lumbosacral radiculopathy is essential to correlate clinical symptoms and signs with the finding detected in the MRI to arrive at a correct diagnosis and arrange an appropriate management. So this study was done to see the correlation between clinical and MRI finding of radiculopathy at different nerve root level in patients with lumbosacral radiculopathy. It was a cross sectional descriptive study. All 40 patients of lumbosacral radiculopathy who were presented to Rajshahi Medical College Hospital during the study period from 01/11/2011 to 30/10/2012 were included in the study. There were 30 males and 10 females having an M: F ratio of 3:1. Mean age of total patients 43 + 14.74 years. 67.5% patients were between 20 to 50 years and 60% patients were performing heavy work. 67.5% patients had unilateral involvement while 32.6% patients had bilateral involvement. 72.5% patients had muscle weakness and 27.5% had no muscle weakness. 67.5% patients had sensory impairment and 32.5% had no sensory involvement. Knee jerk changes were present in 60% patients and ankle jerk changes in 66.66% patients. As expected 52.18% had L5 and 32.61% had S1 radiculopathy. The difference in clinical and MRI detection of root involvement was statistically significant (p value < 0.05) in both sides at L4, L5 and S1 root levels but there was no significant difference at the L3 root level (p value 1.00) Intervertebral disc herniation was the commonest cause of lumbosacral radiculopathy (72.32%) and second common cause was spinal canal stenosis (19.44%). Others are intervertebral disc budging (61.52%), disc protrusion (23.08%) and disc extrusion (15.38%). Correlation between clinical severity and MRI grading of lumbosacral radiculopathy which was statistically significant. So, it is concluded that clinical findings correlate well with MRI finding, but all MRI abnormalities need not have a clinical significanceTAJ 2015; 28(1): 32-39

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Study of nerve root block procedure as a diagnostic and therapeutic aid in lumbosacral radiculopathy

Indian Journal of Pain ◽

10.4103/0970-5333.186470 ◽

2016 ◽

Vol 30 (2) ◽

pp. 127

Author(s):

RahulMadhukar Salunkhe ◽

Tushar Pisal ◽

YuvrajSingh Hira ◽

Ashutosh Singh ◽

JayJanakbhai Patel ◽

...

Keyword(s):

Nerve Root ◽

Lumbosacral Radiculopathy ◽

Nerve Root Block

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Critical Appraisal of a Treatment Publication: Electrical Stimulation for the Treatment of Dysphagia

Perspectives on Swallowing and Swallowing Disorders (Dysphagia) ◽

10.1044/sasd11.4.12 ◽

2002 ◽

Vol 11 (4) ◽

pp. 12-14 ◽

Cited By ~ 1

Author(s):

James L. Coyle

Keyword(s):

Electrical Stimulation ◽

Critical Appraisal

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Rating Spinal Nerve Extremity Impairment Using the Sixth Edition

Guides Newsletter ◽

10.1001/amaguidesnewsletters.2009.julaug01 ◽

2009 ◽

Vol 14 (4) ◽

pp. 1-6

Author(s):

Christopher R. Brigham

Keyword(s):

Nerve Root ◽

Spinal Nerve ◽

Upper Extremities ◽

Motor Deficits ◽

Nerve Injuries ◽

Sixth Edition ◽

Federal Employee ◽

Nerve Root Injury ◽

Root Injury ◽

Rating Process

Abstract The AMAGuides to the Evaluation of Permanent Impairment (AMA Guides), Sixth Edition, does not provide a separate mechanism for rating spinal nerve injuries as extremity impairment; radiculopathy was reflected in the spinal rating process in Chapter 17, The Spine and Pelvis. Certain jurisdictions, such as the Federal Employee Compensation Act (FECA), rate nerve root injury as impairment involving the extremities rather than as part of the spine. This article presents an approach to rate spinal nerve impairments consistent with the AMA Guides, Sixth Edition, methodology. This approach should be used only when a jurisdiction requires ratings for extremities and precludes rating for the spine. A table in this article compares sensory and motor deficits according to the AMA Guides, Sixth and Fifth Editions; evaluators should be aware of changes between editions in methodology used to assign the final impairment. The authors present two tables regarding spinal nerve impairment: one for the upper extremities and one for the lower extremities. Both tables were developed using the methodology defined in the sixth edition. Using these tables and the process defined in the AMA Guides, Sixth Edition, evaluators can rate spinal nerve impairments for jurisdictions that do not permit rating for the spine and require rating for radiculopathy as an extremity impairment.

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