Compressive Radiculopathy Research Articles

62-Year-Old Man With Back Pain and Lower Extremity Weakness

62-Year-Old Man With Back Pain and Lower Extremity Weakness

Microsurgical Anterior Cervical Foraminotomy (Uncoforaminotomy) for the Treatment of Compressive Radiculopathy

Cervical radiculopathy is typically caused because of posterolateral disc herniation or spondylotic foraminal stenosis. Most of the times, either direct anterior excision necessitating fusion or indirect posterior decompression is used as a standard surgical treatment for the same. However, anterior decompression has been used widely. Different techniques can be used. The authors report the clinical application of a new microsurgical technique. The cervical anterior foraminotomy (uncoforaminotomy), which is used for the surgical treatment of unilateral cervical radiculopathy secondary to posterolateral disc herniations or spondylotic foraminal stenoses.

Prevalence of neuromuscular disorders in Qena governorate/Egypt: population-based survey

Background: Few epidemiological studies of the prevalence of neuromuscular disorders have been undertaken. The aim of the study was to estimate the prevalence of the most common types of neuromuscular disorders in Qena governorate/Egypt.Methods: A random sample was taken from 11 districts, involving 9303 inhabitants with 57.3% urban residents and 42.7% rural residence. Patients were diagnosed using a screening questionnaire for the diagnosis of neuromuscular disorders. All positive cases were referred to Qena University hospital where they underwent full clinical, electrophysiological, and laboratory investigations.Results: Out of 9303 participants 448 cases were identified positive during survey. Four hundred and twenty-six cases proved to have neuromuscular disorders giving a crude prevalence rate (CPR) of 4.57%; 408 cases had definite neuropathy and 18 cases had muscular disorders equivalent to CPR of 4.39% and 193/105 respectively. There was a higher prevalence in the rural than urban population. The CPR of focal compression neuropathies was 1.8%, with the majority of cases having carpal tunnel syndrome (CPR = 1.67%). CPR of diabetic neuropathy was 1.67%. The CPR of compressive radiculopathy was 0.34%. Traumatic nerve injury had a CPR 0.06%. The lifetime prevalence of Bell’s palsy was 0.16%. Hereditary motor and sensory neuropathy had a CPR 0.08%. The CPR of idiopathic neuropathy was 0.09% and Infective Leprotic neuropathy was 0.04%. Five patients were diagnosed as having muscular dystrophy and another 5 patients had myotonia with CPR of 54/105 for each. Two cases of myasthenia gravis and another two cases with systemic myopathy were recorded giving a CPR of 21/105.Conclusion: The overall CPR of neuromuscular disorders in the general population in Qena governorate/Egypt was higher than reported in other countries.

GUILLAIN-BARRE SYNDROME AS A DIFFERENTIAL DIAGNOSIS OF LOW BACK PAIN SYNDROME

ABSTRACT Peripheral neuropathies are diseases of the lower motor neurons of the spinal cord and brainstem it can often mimic symptoms associated with the injuries of compressive radiculopathy. They are manifested by tingling, coldness, numbness, burning, pain, hypersensitivity, weakness, atrophy, postural hypotension, impotence, anhidrosis, and urinary incontinence. Therefore, it is important in the diagnostic strategy to keep in mind this type of pathology, especially when it comes to patients already in the 6th decade of life.

Sustained Local Release of Methylprednisolone From a Thiol-Acrylate Poly(Ethylene Glycol) Hydrogel for Treating Chronic Compressive Radicular Pain.

A preclinical animal model of chronic ligation of the sciatic nerve was used to compare the effectiveness of a slow-release hydrogel carrying methylprednisolone to methylprednisolone injection alone, which simulates the current standard of care for chronic compressive radiculopathy (CR). To extend the short-term benefits of steroid injections by using a nonswelling, biodegradable hydrogel as carrier to locally release methylprednisolone in a regulated and sustained way at the site of nerve compression. CR affects millions worldwide annually, and is a cause of costly disability with significant societal impact. Currently, a leading nonsurgical therapy involves epidural injection of steroids to temporarily alleviate the pain associated with CR. However, an effective way to extend the short-term effect of steroid treatment to address the chronic component of CR does not exist. We induced chronic compression injury of the sciatic nerves of rats by permanent ligation. Forty-eight hours later we injected our methylprednisolone infused hydrogel and assessed the effectiveness of our treatment for 4 weeks. We quantified mechanical hyperalgesia using a Dynamic Plantar Aesthesiometer (Ugo Basile, Stoelting Co., IL, USA), whereas gait analysis was conducted using the Catwalk automated gait analysis platform (Noldus, Leesburg, VA, USA). Macrophage staining was performed with immunohistochemistry and quantification of monocyte chemoattractant protein-1 in sciatic nerve lysates was performed with multiplex immunoassay using a SECTOR Imager 2400A (Meso Scale Discovery, Rockville, MA, USA). We demonstrate that using the hydrogel to deliver methylprednisolone results in significant (P < 0.05) reduction of hyperalgesia and improvement in the gait pattern of animals with chronic lesions as compared with animals treated with steroid alone. In addition, animals treated with hydrogel plus steroid showed significant reduction in the number of infiltrating macrophages at the sciatic nerve and reduced expression of the neuroinflammatory chemokine monocyte chemoattractant protein-1 (P < 0.05). Use of hydrogels as carriers for sustained local release of steroids provides significantly better control of pain in an animal model of chronic CR. Our steroid-infused hydrogel could be an effective extender of the short-term benefits of epidural steroid injections for patients with chronic compression-induced radicular pain. N/A.

A Five-year Prospective Clinical and Radiological Review of a Semi-constrained Ceramic-Ceramic Cervical Disc Replacement

Introduction Artificial cervical disc replacement [CDR] has emerged as a viable treatment alternative to fusion for the management of symptomatic compressive radiculopathy and / or myelopathy. This paper evaluates the clinical and radiological outcomes of patients treated with a second generation semi-constrained CDR with a ceramic-ceramic articulation. Material and Methods We conducted a prospective cohort study of all patients undergoing a cervical disc replacement for cervical disc pathology, during the period from April 2007 to April 2010 using the Discocerv ceramic disc replacement. 42 patients were available for final clinical and radiological follow-up. Both, clinical and radiological evaluation was performed at each clinical visit at 6 weeks, 6 months, 12 months and 2 years and 5 years. Results Three patients were lost for follow-up. C5-C6 was the commonest level. There were 34 single level cases and 8 two level cases. The NDI improved significantly ( p &lt; 0.05) from a mean preoperative score of 56% to a score of 20% at final follow-up. The mean preoperative mobility at the index level unit was 12.2 ± 4.5°, this decreased to 7.9 ± 3.2° at six weeks, but slightly increased to 12.9 ± 2.9° at 1 year (gain not significant). Heterotrophic ossification [HO] was noted in 10 [23%] patients. Conclusion Based on our study of cervical disc replacement with a ceramic-ceramic bearing surface, this appears to be a viable option in the treatment of variety of cervical pathologies. This ceramic-ceramic interface eliminates potential problems like metallosis but further longer-term results should be reported.

Lumbar spinal intradural extramedullary lipoma associated with spina bifida and tethered cord

A 21-year-old man presented with low back pain, left leg weakness, and walking difficulties. Magnetic resonance imaging of the lumbar spine revealed an intraspinal intradural extramedullary tumor at the level of L1–L3, causing posterior cord compression. The lesion had a signal identical to that of the subcutaneous adipose tissue on T1and T2weighted images, and suppressed on fat-saturated images (Fig. 1). It did not enhance on postcontrast images (Fig. 2). These magnetic resonance imaging findings allowed the diagnosis of spinal intradural extramedullary lipoma. Besides the tumor, there was a low-lying conus terminating at level L5–S1 and spina bifida of L5 and S1 (Figs. 1–3). Surgery was performed, and the lipoma was completely removed. Pathology confirmed the diagnosis. Intradural extramedullary lipomas of the lumbar spine are rare, and may cause symptoms related to mass effect and secondary compressive radiculopathy. These lesions may be a manifestation of spina bifida and a common cause of the tethered cord syndrome.

Use of Autologous Serum in Treatment of Lumbar Radiculopathy Pain. Pilot Study

The aim of the study was to determine the usefulness of autologous serum in the treatment of patients with signs of radicular compression in the course of lumbar discopathy. The treatment was based on the use of autologous conditioned serum (ACS, Orthokine). A total of 15 patients with MRI-confirmed single-level nucleus pulposus herniation with signs of radicular compression without paresis in a clinical examination received 6 doses of ACS administered by the same doctor under ultrasound guidance from a posterolateral approach to the area of an intervertebral foramen. The clinical condition of the patients was reassessed at 1 month and 3 months after the administration of the last dose. Pain intensity was assessed with a scoring system and a VAS scale, and radicular oedema was assessed with the following clinical tests: one-leg stance (OLS test) and straight leg raise (SLR test); the disability level was measured with the Oswestry Disability Index. Out of 15 patients, 2 persons had to undergo surgery due to increasing pain. The other subjects showed a statistically significant reduction of pain and clinical signs of radicular compression as well as improved Oswestry scores. No radicular damage following injections or serious complications of the treatment were found. 1. The Orthokine therapy conducted under ultrasound guidance may be an interesting option in the treatment of compression radiculopathy in the course of radicular compression due to a herniated disc. 2. The present pilot study provides the rationale for studying larger groups of subjects in controlled studies over longer periods of time.

New physiological classification of pains: current concept of neuropathic pain

BACKGROUND AND OBJECTIVES Neuropathic is a complex entity and experts have tried to define it in a clearer and more objective way for its diagnosis to be more accurate, especially for non-specialists. Aiming at evaluating studies on the subject and their repercussion on medical practice, a systematic review was carried out from 2000 to 2016 on published studies about neuropathic pain, its definition and involved physiological aspects, using Pubmed, Cochrane and LILACS as databases. CONTENTS The new concept accepted by the International Association for the Study of Pain in 2011 considers neuropathic as pain induced by injury or disease directly affecting the system. So, dysfunction, considered a vague term, was replaced by disease, and nervous system was replaced by somatosensory system, to topographically delimit the disease. The new definition has created diagnoses based on clinical history and anatomic location, associated to evidential tests. Conditions such as diabetic polyneuropathy, post-herpetic neuropathy, compressive radiculopathy, other peripheral neuropathies and thalamic were well covered by new guidelines, however pains such as essential trigeminal neuralgia, fibromyalgia, complex regional syndrome type I, were excluded from the new definition. CONCLUSION Current concept is not ideal; it is limited and excludes major states and although the new classification has improved the understanding of neuropathic pain, further studies are needed on the subject.

Radiological Signs of Adjacent Segment Degeneration Patients with Cervical Spondylotic Radiculopathy Treated with Posterior Cervical Cages: Two-Year Follow-Up

BACKGROUND CONTEXT: Select patients with nerve compression and cervical radiculopathy secondary to spondylosis can be successfully treated with indirect posterior cervical decompression and fusion with posterior cervical cages. Cervical fusion may have an influence on adjacent segment degeneration (ASD). PURPOSE: The aim of this study was to assess radiological signs of ASD at 2 years follow-up in patients treated with posterior cervical cages for cervical spondylotic radiculopathy. STUDY DESIGN/SETTING: Retrospective evaluation of cervical radiographs. PATIENT SAMPLE: Fifty-three patients who underwent posterior cervical fusion with DTRAX cervical cages for cervical spondylotic radiculopathy were enrolled into the study. The lateral cervical X-ray images were taken in neutral position preoperatively and at 1 and 2 years postoperatively. OUTCOME MEASURES: The adjacent levels were evaluation consisted of measurements of:1) Proximal junctional kyphosis (PJK);2) Disc height ratio (DHR) – ratio of the disc height and the lower vertebrae height measured in the in the middle;3) Heterotopic ossification (HO) – none,!50%, O50 % , complete bridging of the disc;4) Kellgren and Lawrence Osteoarthritis Severity Grade (OSG).5) Neck Disability Index(NDI), Visual Analog Scale(VAS), and SF-12 Mental(MCS) and Physical Component Score(PCS). METHODS: The results were compared with ANOVA test, with p!0.05 considered as significant. ASD was defined as an increase of HO or OSG by 1 grade in new cases and by 2 grades if pre-existing disc degeneration was present before surgery (DDS). RESULTS: There were no revision surgeries at the operated level or at adjacent levels. Disc degeneration signs were present before surgery (DDS) in 21 patients in upper level and in 22 patients in lower level. In 2 patients there were new grade 1 ASD changes, 1 in level above and 1 in level below at 2 years postoperatively. In patients with pre-existing disc degeneration at the adjacent level, there were 0 cases of adjacent level degeneration progression of 2 grade or more. There were no significant changes in DHR and in PJK in all patients and in patients with ASD, however, there were tendency in patients with signs of ASD to decrease DHR in time. The mean PJK before surgery was -1.02 64.6 , 1 year after surgery -0.86 64.7 and 2 years after surgery was -0.59 65.4 ; p50.5342The mean DHR in all patients before surgery was 43.3 66.3 , 1 year after surgery 43.3 66.6 and 2 years after surgery was 43.1 66.8 ; p50.7290The mean DHR in ASD patients before surgery was 44.1 65.6 , 1 year after surgery 42.667.2 and 2 years after surgery was 40.9 67.8 ; p50.1836.The mean preop and 2-year scores were: NDI: 32.3 vs 9.1 (p!0.0001); VAS Neck Pain: 7.4 vs 2.6(p!0.0001); VAS Arm Pain: 7.4 vs 2.6 (p!0.0001); SF-12 PCS: 34.6 vs 43.6(p!0.0001) and SF-12 MCS: 40.8 vs 51.4 (p!0.0001). CONCLUSIONS: Indirect decompression and posterior cervical fusion using the DTRAX Cage may be an effective option in select patients with single level cervical radiculopathy. In patients treated with posterior cervical cage progression of disc degeneration is much more common on the basis of preoperative changes than new ASD. Posterior cervical fusion with cervical cage does not induce or accelerate adjacent segment degeneration in the great majority of patients (more than 1 score). Further evaluation to establish long-term incidence of ASD in patients treated with posterior cervical cage is needed. FDA DEVICE/DRUG STATUS: DTRAX Cervical Cage (Providence Medical Technology, Inc.) (Approved for this indication).

Isolated lumbar spinal hydatid cyst- a rare presentation

We are reporting a case of isolated lumbar spinal hydatid cyst with erosion of vertebral corpus and compressive radiculopathy. Ultrasonography of the abdomen and Computed Tomography CT of the lumbar spine suggested the evidence of spinal hydatid cyst.

OVERVIEW: FEATURES OF VERTEBROGENIC LUMBOSACRAL CHRONIC PAIN SYNDROME

There are a biopsychosocial pain model, it consist of biological (anatomical, physiological), sociocultural (level of education, traditions) and psychological (cognitive, affective, behavioural) components. Also there are nociception (myofascial) and neuropathic (compression radiculopathy) components. The anatomical condition of the vertebral-motor segment often not correlated with the severity of pain syndrome. Assess the state of the peripheral segmental apparatus, peripheral nerves of the lower extremities, you can use stimulation ENMG.

Possible role of alpha-lipoic acid in the treatment of peripheral nerve injuries

Recent findings on the antioxidant effects of pretreatment with α-lipoic acid (α-LA) on the crush injury of rat sciatic nerve confirm the possible usefulness of α-LA administration in humans with peripheral nerve injuries. We discussed this issue in relation with our recent results in which the combined employment of α-LA and γ-linolenic acid with a rehabilitation program for six weeks reduced sensory symptoms and neuropathic pain in patients with compressive radiculopathy syndrome from disc-nerve root conflict in comparison with patients submitted to rehabilitation program alone for six weeks.

Total cervical disk replacement with a prestige LP® prosthesis: clinical and functional outcomes

Objective: To determine the clinical and functional results of short- and medium-term cervical arthroplasty with the Prestige LP® prosthesis for the treatment of compressive myelopathy, radiculopathy and axial pain with radiculopathty. Methods: This retrospective study, conducted from 2009 to 2012, included 18 patients. Only 16 were found for the second stage of research, conducted in 2011 and 2012. Pre- and postoperative assessments were carried out using the CSOQ (Cervical Spine Outcomes Questionnaire). Odom criteria were used only in the postoperative evaluation. Both were translated and adapted to the local culture. Results: There was no postoperative radiculopathy or other complications requiring prolonged hospitalization. In most patients, there was a significant improvement in axial pain and radiculopathy, and there was only one indication of conversion to fusion. Conclusions: In selected cases of cervical degenerative disc disease, herniated cervical disc and compressive myeolopathy, cervical arthroplasty proved to be an effective and safe treatment in the short and medium terms.

Transient compressive lumbar radiculopathy following post-epidural blood patch

Transient compressive lumbar radiculopathy following post-epidural blood patch

Diagnostic advantage of S1 foramen-evoked H-reflex for S1 radiculopathy in patients with diabetes mellitus

Hoffmann reflex to tibial nerve stimulation at the popliteal fossa (tibial H-reflex) is routinely used to evaluate S1 radiculopathy. However, it lacks sensitivity because other lesions along this reflex circuit affect the H-reflex bilaterally. This study was undertaken to determine whether the H-reflex evoked by stimulating proximally at the S1 foramen (S1 foramen H-reflex) could improve S1 root lesion evaluation sensitivity in patients with diabetes mellitus. A randomized paired study was designed to evaluate tibial and S1 foramen H-reflexes; bilateral H-M interval (HMI) and H-reflex latency were compared in 22 diabetic patients with unilateral S1 radiculopathy. Other electrophysiological evaluations included standard tibial conduction studies, sural conduction studies and needle electromyography (EMG). The S1 foramen H-reflex had a significantly higher sensitivity (91.0%, 20 of 22) in evaluating S1 radiculopathy than the conventional tibial H-reflex (63.6%, 14 of 22, p < 0.05). Bilateral tibial compound muscle action potential amplitudes were reduced in 3 patients, and sural sensory nerve action potential amplitudes decreased in 7 patients. Needle EMG revealed denervation restricted to the paraspinal muscle and myotomes supplied by the S1 nerve root on the ipsilateral side in 18 patients, and multiple lumbosacral nerve roots were involved bilaterally in the other 4 patients. Our results demonstrate that the S1 foramen H-reflex is a more sensitive assessment of S1 compressive radiculopathy in patients with diabetes mellitus.

Diagnostic Usefulness of Dermatomal Somatosensory Evoked Potentials by Low Intensity Stimulation in Cervical Compressive Radiculopathy

Diagnostic Usefulness of Dermatomal Somatosensory Evoked Potentials by Low Intensity Stimulation in Cervical Compressive Radiculopathy

Impaired cognition and hemispatial neglect in a woman with neck pain

MRI brain (Fig. 1A-C Images in Neuroscience: Question) revealed multiple subcentimeter gadolinium-enhancing foci throughout the leptomeninges and cortex. Cerebrospinal fluid (CSF) analysis revealed pleomorphic lymphocytosis with a low CSF/blood glucose concentration ratio (0.2, normal range > 0.6). Although infective processes, including tuberculosis (TB) are possible, the suspicious lesion behind the left ventricle (Fig. 1D Images in Neuroscience: Question) made cerebralmetastases from lung cancer themost likely diagnosis. Cerebral metastases from haematological dissemination usually results in a single or few nodules, which typically seed to the grey– white matter junction and are surrounded by oedema. This case is unusual, as there are numerous nodules throughout the leptomeninges and cortex andnoevidence of perilesional oedemaormass effect. Such ‘‘miliary’’metastatic tumoursor carcinomatousencephalitis are rare and usually present in patients with known systemic disease. Carcinomatous meningitis occurs in 5% of systemic malignancies and should be suspected in patients with aseptic meningitis, especially when underlying lung, breast or gastrointestinal tumours are present. Here, it is difficult to determine whether tumour cells spread from the brain parenchyma to the CSF or visa versa. Once in the subarachnoid space, however, dissemination to multiple meningeal sites overlying the brain and spinal cord is inevitable and there may be spread to the underlying parenchyma. Carcinomatous meningoencephalitis is characterized by cranial or spinal root neuropathies due to leptomeningeal disease in combination with focal neurological deficits or altered mental state attributable to cortical disease. Compression of cranial nerves as they exit the brainstem frequently presents as ophthalmoplegia or facial weakness, while aqueductal obstruction may result in hydrocephalus. Spinal root involvement presents as neck or back pain associated with compressive radiculopathies. Cortical involvement results in headache or altered mental state and disruption of the blood–brain barrier typically manifests as focal deficits, seizures or encephalopathy. In leptomeningeal disease CT scans are usually unremarkable and calcification or microhaemorrhage of cortical nodules is

A community-based epidemiological study of peripheral neuropathies in Assiut, Egypt

Background: There is very little published information about the prevalence, patterns, and predictors of peripheral neuropathies. The current study is a community-based survey was conducted in the Assiut Governorate to estimate their prevalence and clinical profile.Material and methods: A door-to-door study was carried out on 42 223 persons from rural and urban communities in the Assiut Governorate, Egypt. There were 13 288 (31·5%) subjects from the urban and 28 935 (68·5%) from the rural area. All subjects filled in a questionnaire designed specifically for diagnosis of peripheral neuropathy. Positive cases were then given a complete medical and neurological examination, routine laboratory tests, neurophysiology, and neuroimaging (magnetic resonance).Results: The crude prevalence rate (CPR) of peripheral neuropathy was 3181/100 000 inhabitants. There was a significantly higher prevalence in the rural compared with the urban population (3795 versus 1844/100 000) and in females than males (4473 versus 1943/100 000; P<0·001 for both). The most common type reported was entrapment neuropathy (736 cases with CPR of 1743/100 000), particularly carpal tunnel syndrome (1686/100 000). Diabetic neuropathy was the most common non-compressive neuropathy with a CPR of 649/100 000. Type II diabetes was recorded in 241 patients with a CPR of 571/100 000. Compressive radiculopathy had a crude prevalence of 358/100 000; traumatic and iatrogenic radiculopathy had a prevalence rate of 149/100 000. Less common conditions were: uremic neuropathy (21/100 000) hepatic neuropathy (14/100 000), Bell’s palsy (28/100 000), Guillian–Barre’ syndrome (12/100 000), chronic inflammatory demyelinating polyneuropathy (12/100 000), hereditary sensory motor neuropathy (12/100 000), and idiopathic neuropathy (92/100 000).Conclusion: The overall prevalence of peripheral neuropathies was high in comparison to other studies. Entrapment neuropathy, diabetic neuropathy, and spondylotic radiculopathy were the most common. Overall, the prevalence of peripheral neuropathy was higher in the rural than in the urban population.

Non-invasive high voltage electrical stimulation as a monitoring tool of nerve root function in lumbosacral surgery

ObjectiveTo verify the safety and clinical use of non-invasive high-voltage electrical stimulation (HVES) in patients with compressive radiculopathy. To test the feasibility of HVES to survey nerve root function during lumbosacral surgery. MethodsIn 20 patients undergoing lumbosacral surgery for degenerative spinal diseases, compound muscle action potentials (CMAPs) evoked by maximal HVES were bilaterally recorded throughout surgery from L3 to S2 radicular territories. A preliminary study was performed in awake patients to rule out detrimental effects caused by HVES. ResultsPreoperative study confirmed the safety of HVES. Unexpectedly, a transient but significant remission of pain was observed after root stimulation. Intraoperative monitoring (IOM) was accomplished in all patients. HVES never hindered surgical procedures and never caused mechanical damage within the operatory field. In 4 patients acute, highly focal and reversible conduction failure was promptly detected by HVES in radicular territories congruent with the root manipulated at that moment. ConclusionsHVES is a safe and sensitive tool to monitor nerve root function in lumbosacral surgery. SignificanceThe method is based on the assumption that any acute conduction failure occurring during surgery can be immediately and unambiguously detected by HVES if root stimulation is supramaximal and delivered rostral to the surgical level.