Radiculopathy Group Research Articles

Risk factors in cervical spondylosis.

Cervical spondylosis is essentially a degenerative disorder common after fourth decade. It has been seen that radiological evidence of cervical spondylosis do not necessarily co-relate with clinical findings. This discrepancy has been attributed to the morphometric dimensions of the vertebrae, age, sex, race, occupation, weight and height of the patients. The objective of this study is to co-relate the variables like age, sex, race, occupation, vertebral body diameter, canal diameter, canal body ratio of cervical spine vertebrae with cervical spondylosis cases with normal population. In this hospital based, case control, consent based, cross-sectional, clinico-radiological study 200 individuals (controls-100, cases-100) who were subjected to lateral projection radiographs of cervical spine. Their age, sex, race, occupation, height, weight and mid-sagittal canal diameter (CD), sagittal vertebral body diameter (VBD) and the canal-body ratio (CBR) of the cervical vertebrae was recorded and analyzed statistically. There was no relation between vertebral dimensions and clinical groups. In radiculopathy group, age and height showed significance on univariate analysis. While only age remained significant on multivariate analysis. In neck pain group age, sex, and height showed significance on univariate analysis while in multivariate analysis age, sex and occupation were significant risk factors.

Arthroplasty for cervical spondylotic myelopathy: similar results to patients with only radiculopathy at 3 years' follow-up.

Cervical arthroplasty has been accepted as a viable option for surgical management of cervical spondylosis or degenerative disc disease (DDD). The best candidates for cervical arthroplasty are young patients who have radiculopathy caused by herniated disc with competent facet joints. However, it remains uncertain whether arthroplasty is equally effective for patients who have cervical myelopathy caused by DDD. The aim of this study was to compare the outcomes of arthroplasty for patients with cervical spondylotic myelopathy (CSM) and patients with radiculopathy without CSM. A total of 151 consecutive cases involving patients with CSM or radiculopathy caused by DDD and who underwent one- or two-level cervical arthroplasty were included in this study. Clinical outcome evaluations and radiographic studies were reviewed. Clinical outcome measurements included the Visual Analog Scale (VAS) of neck and arm pain, Japanese Orthopaedic Association (JOA) scores, and the Neck Disability Index (NDI) in every patient. For patients with CSM, Nurick scores were recorded for evaluation of cervical myelopathy. Radiographic studies included lateral dynamic radiographs and CT for detection of the formation of heterotopic ossification . Of the 151 consecutive patients with cervical DDD, 125 (82.8%; 72 patients in the myelopathy group and 53 in the radiculopathy group) had at least 24 months of clinical and radiographic follow-up. The mean duration of follow-up in these patients was 36.4 months (range 24-56 months). There was no difference in sex distribution between the 2 groups. However, the mean age of the patients in the myelopathy group was approximately 6 years greater than that of the radiculopathy group (53.1 vs 47.2 years, p < 0.001). The mean operation time, mean estimated blood loss, and the percentage of patients prescribed perioperative analgesic agents were similar in both groups (p = 0.754, 0.652, and 0.113, respectively). There were significant improvements in VAS neck and arm pain, JOA scores, and NDI in both groups. Nurick scores in the myelopathy group also improved significantly after surgery. In radiographic evaluations, 92.5% of patients in the radiculopathy group and 95.8% of those in the radiculopathy group retained spinal motion (no significant difference). Evaluation of CT scans showed heterotopic ossification in 34 patients (47.2%) in the myelopathy group and 25 patients (47.1%) in the radiculopathy group (p = 0.995). At a mean of over 3 years postoperatively, no secondary surgery was reported in either group. The severity of myelopathy improves after cervical arthroplasty in patients with CSM caused by DDD. At 3-year follow-up, the clinical and radiographic outcomes of cervical arthroplasty in DDD patients with CSM are similar to those patients who have only cervical radiculopathy. Therefore, cervical arthroplasty is a viable option for patients with CSM caused by DDD who require anterior surgery. However, comparison with the standard surgical treatment of anterior cervical discectomy and fusion is necessary to corroborate the outcomes of arthroplasty for CSM.

Potential Advantages of the H-Reflex of the Biceps Femoris-Long Head in Documenting S1 Radiculopathy

A novel H-reflex method using the biceps femoris-long head (BF-LH) was investigated to collect the normative data for this reflex arc and assess its clinical utility for S1 radiculopathy evaluation. Comparability with conventional tibial and Sol H-reflex findings was also determined. BF-LH H-reflexes were recorded using surface electrodes to S1-root stimulation in 43 unilateral S1 radiculopathy patients (radiculopathy group) and 34 normal subjects (control group) from March 2009 to December 2011. H-M interval and peak-to-peak amplitudes were measured. The BF-LH H-reflex and the H-reflex from the soleus muscle (Sol H-reflex) to both tibial nerve stimulation (tibial H-reflex) and S1-root stimulation were used and compared for application in S1 radiculopathy evaluation. BF-LH H-reflexes were reliably recorded for all control group subjects. Abnormal BF-LH H-reflexes were recorded for 40 (93.0%) radiculopathy group patients in the involved extremity, and abnormal involved side tibial H-reflexes and Sol H-reflexes were recorded in 31 (72.1%) and 41 (95.3%) radiculopathy group patients, respectively. The BF-LH H-reflex exhibited significantly higher sensitivity for evaluation of S1 radiculopathy, accurate in 40 (93.0%) radiculopathy group patients, than that provided by the conventional tibial H-reflex of only 31 (72.1%) (P < 0.05). The BF-LH H-reflex is a highly sensitive and reliable clinical tool for evaluation of the S1 spinal reflex pathway in radiculopathy that is distinct from the Sol H-reflex and conventional tibial H-reflex arcs.

Sensory Hyperalgesia is Characteristic of Nonspecific Arm Pain

Nonspecific arm pain (NSAP) is a common clinical entity, the pathophysiological mechanisms of which are poorly understood. The purpose of this study was to investigate sensory profiles in individuals with nonspecific arm pain compared with cervical radiculopathy and pain-free controls. Forty office workers with NSAP, 17 people with cervical radiculopathy, and 40 pain-free controls were assessed by means of quantitative sensory testing (thermal and vibration detection thresholds; thermal and pressure pain thresholds), tests for neural tissue sensitivity, and questionnaires. Between-group comparisons were conducted using Kruskal-Wallis tests. An exploratory factor analysis was used to determine characteristic features in NSAP. Both patient groups demonstrated cold and pressure pain sensitivity (P<0.003; P<0.05) and neural tissue sensitivity (P<0.001). The NSAP group also demonstrated heat pain sensitivity (P<0.001). Both patient groups demonstrated hypoaesthesia to vibration thresholds (P<0.05), whereas thermal hypoaesthesia was only evident in the cervical radiculopathy group (P<0.05). Exploratory factor analysis revealed pressure and thermal pain sensitivity as the key characteristics of this NSAP group. Sensory profiles in NSAP and cervical radiculopathy differ. NSAP is characterized by widespread sensitivity to thermal and pressure pain in the absence of thermal hypoaesthesia, whereas cervical radiculopathy is characterized by the presence of thermal and vibratory hypoaesthesia as well as more localized cold and pressure pain sensitivity. The identification of widespread sensory hypersensitivity in NSAP has important implications for clinical decision making.

The Location of Multifidus Atrophy in Patients With a Single Level, Unilateral Lumbar Radiculopathy

ObjectiveTo identify the correlations between the location of multifidus atrophy and the level of lumbar radiculopathy.MethodsThirty-seven patients who had unilateral L4 or L5 radiculopathy were divided into 2 groups; the L4 radiculopathy (L4 RAD) group and the L5 radiculopathy (L5 RAD) group. Bilateral lumbar multifidus muscles at the mid-spinous process level of L4 vertebra (L4 MSP), the mid-spinous process level of L5 vertebra (L5 MSP), and the mid-sacral crest level of S1 vertebra (S1 MSC) were detected in T1 axial magnetic resonance imaging. The total muscle cross-sectional area of multifidus muscles (TMCSA) and the pure muscle cross-sectional area of multifidus muscles (PMCSA) were measured by a computerized analysis program, and the ratio of PMCSA to TMCSA (PMCSA/TMCSA) was calculated.ResultsThere were no significant differences in TMCSA between the involved and the uninvolved sides in both groups. PMCSA was only significantly smaller at the S1 MSC on the involved side as compared with the uninvolved side in the L5 RAD group. The ratio of PMCSA to TMCSA was the lowest at the L5 MSP on the involved side in the L4 RAD group and at the S1 MSC on the involved side in the L5 RAD group.ConclusionOur findings suggest that the most severe atrophy of multifidus muscle may occur at the mid-spinous process or mid-sacral crest level of the vertebra which is one level below the segmental number of the involved nerve root in patients with a single-level, unilateral lumbar radiculopathy.

Correlation between transcranial motor and somatosensory-evoked potential findings in cervical myelopathy or radiculopathy during cervical spine surgery

Background: The correlation between electrophysiological recordings, MR images, and physical findings in cervical stenosis and cervical myelopathy are still open to debate. The goal of this study was to determine sensitivity of motor-evoked potential (MEP) and somatosensory-evoked potential (SSEP) in detecting cervical myelopathy and its correlates with the MRI findings in patients undergoing cervical spine surgeries.Method: Transcranial motor-evoked potentials (TcMEPs) and SSEPs were performed intraoperatively in 100 patients. The ‘baseline’ recordings of TcMEPs and SSEPs were correlated with patient’s physical findings as well as the MR images.Results: Posterior tibial and median nerves’ scalp SSEP latencies were increased in myelopathic patients compared to the radiculopathy group. MEPs recorded from distal muscles such as abductor pollicis brevis and adductor hallucis (AH) muscles were more likely to be absent in myelopathic patients compared with the patients with only radiculopathy. The myelopathic patients were more likely to have no response (NR) for the lower extremity SSEP test compared with radiculopathy patients.Conclusion: MEP shows more sensitivity toward detecting myelopathy which is correlated well with abnormal MR images.

Anorectal function and the effect of biofeedback therapy in ambulatory spinal cord disease patients having constipation

Objective. Constipation in patients with mild spinal cord disease is not well investigated yet. We aimed to investigate anorectal function and the effect of biofeedback therapy in constipated patients with mild spinal cord diseases. Material and methods. A total of 14 constipated patients with myelopathy and 32 with radiculopathy were enrolled retrospectively. All patients were able to walk independently. The control group comprised of 100 constipated patients without any neurologic problem. Colonic transit time and the presence of dyssynergia were assessed before biofeedback therapy. All patients answered structured questionnaires on constipation, before and after biofeedback therapy. Results. The mean rectosigmoid colonic transit time of the myelopathy group was significantly delayed (myelopathy, 18.6 ± 14.6 h; radiculopathy, 12.8 ± 11.9 h; control, 9.6 ± 11.2 h; p = 0.032). Delay in total colonic transit time was more frequent in the myelopathy group (myelopathy, 57.1%; radiculopathy, 23.3%; control, 18.5%; p = 0.004). On anorectal manometry, the squeezing pressure of the anal sphincter was decreased in the myelopathy group (myelopathy, 132.3 ± 73.3 mmHg; radiculopathy, 179.9 ± 86.1 mmHg; control 200.4 ± 82.4 mmHg; p < 0.05). The success rate of biofeedback therapy was lower in the myelopathy group (28.6% for myelopathy vs. 62.0% for control group; p = 0.034). The response rate to biofeedback therapy was similar between radiculopathy and control group (62.5% for radiculopathy vs. 62.0% for control group; p = 1.000). Conclusions. In constipation associated with mild myelopathy, delayed colonic transit and dyssynergic defecation were major pathophysiologic abnormalities and biofeedback was less effective compared with control group. However, in the radiculopathy group, biofeedback was as effective as in the control group.

Adductor T reflex abnormalities in patients with decreased patellar reflexes

The adductor reflex (AR) is a tendon reflex that has various features that differ from other tendon reflexes. This reflex was tested in different disorders presenting with diminished patellar reflexes such as diabetic lumbosacral radiculoplexus neuropathy (DLRPN), L2-L4 radiculopathy, and distal symmetric diabetic neuropathy (diabetic PNP). The AR and crossed-AR (elicited by tapping the contralateral patellar tendon) were recorded using concentric needle electrodes. Additionally, the patellar T reflex (vm-TR) and vastus medialis H reflex (vm-HR) were recorded using surface electrodes. AR was recorded in only one out of eight patients with DLRPN, but it was recorded in 21 out of 22 patients with L2-L4 radiculopathy (95.5%). Of these reflexes, only AR showed prolonged latency in the L2-L4 radiculopathy group. The latencies of AR, vm-TR, and vm-HR were prolonged in patients with diabetic PNP. We conclude that AR can be useful in the differential diagnosis of some lower motor neuron disorders that present with patellar reflex disturbance. Muscle Nerve 40: 264-270, 2009.

Whiplash (Grade II) and Cervical Radiculopathy Share a Similar Sensory Presentation: An Investigation Using Quantitative Sensory Testing

Recent research has identified the coexistence of generalized sensory hypersensitivity and hypoesthetic changes suggestive of a neuropathic component to chronic whiplash associated disorders (WAD). This study aimed to compare chronic whiplash with a cervical neuropathic condition-cervical radiculopathy, using Quantitative Sensory Testing. Fifty participants with chronic grade II WAD (>3 mo), 38 participants with radiculopathy, and 31 controls who were age and sex matched to participants with WAD participated in the study. Quantitative Sensory Testing including detection thresholds (electrical, thermal, and vibration) and pain thresholds (pressure, cold) were measured from bilateral hand sites corresponding to innervation areas of the lower cervical nerve roots and a remote site in the lower limb. The whiplash and cervical radiculopathy groups demonstrated lower pain thresholds to both pressure and cold stimuli at all sites compared with the controls (P<0.01). The symptomatic limbs of the radiculopathy group showed the greatest elevation in detection thresholds for all stimuli compared with the asymptomatic limbs of this group, the whiplash and control groups (P<0.01). There was no difference in detection thresholds between the asymptomatic limbs of the radiculopathy group and the whiplash group (P>0.05) but both these groups showed higher detection thresholds than the controls (P<0.05). Generalized sensory hypersensitivity and hypoesthesia occur in both chronic whiplash and cervical radiculopathy. This may represent disordered central pain processing but could indicate peripheral nerve dysfunction.

Can the Neuropathic Pain Scale Discriminate Between Non-neuropathic and Neuropathic Pain?

1) To determine if the neuropathic pain scale (NPS) can be used to classify chronic pain patients (CPPs) as having primarily neuropathic vs non-neuropathic pain, and furthermore; 2) to determine what, if any, cut-off score can be used to reliably make this determination. A total of 305 CPPs consecutive admissions to The Rosomoff Pain Center were administered the NPS and were assigned a diagnosis according to the physical examination and all available test results. CPPs with a diagnosis of chronic radiculopathy and spondylolysis/degenerative arthritis were segregated into two groups for the purposes of having a group representative of neuropathic pain (chronic radiculopathy) and non-neuropathic pain (spondylolysis/degenerative arthritis). Applying neuropathic pain criteria to each "of these two groups": a neuropathic pain "subtype" was identified within the chronic radiculopathy group; and, a non-neuropathic pain "subtype" was identified within the spondylolysis/degenerative arthritis group. This step was performed in order to assure that the CPPs selected for further analysis were truly representative of neuropathic and non-neuropathic pain. Discriminant function analysis was then employed to determine if NPS scoring could differentiate between these two "subtypes." Results from the discriminant function analysis model were utilized to derive an NPS cut-off score above which CPPs would be classified as having neuropathic pain. For the diagnoses of myofascial pain syndromes, spinal stenosis, epidural fibrosis, fibromyalgia, complex regional pain syndromes 1 and 2, and failed back surgery syndrome, a predicted NPS score was calculated and compared with the cut-off score. Multidisciplinary pain facility. Chronic pain patients. The NPS appeared to be able to separate CPPs into neuropathic pain vs non-neuropathic pain subtypes. The derived cut-off score from the model was 5.53. Myofascial pain syndrome and spinal stenosis had predictive scores lower than this cut-off score at 3.81 and 4.26, respectively. Epidural fibrosis, fibromyalgia, complex regional pain syndromes 1 and 2, and failed back surgery syndrome had predictive scores higher than the cut-off score at 6.15, 6.35, 6.87, 9.34, and 7.19, respectively. The NPS appears to be able to discriminate between neuropathic and non-neuropathic pain. A debate is currently raging as to whether diagnoses, such as fibromyalgia and complex regional pain syndrome 1, can be classified as neuropathic. Our NPS cut-off score results suggest that these diagnoses may have a neuropathic pain component. The reliability and validity of our NPS method will need to be tested further in other neuropathic pain models, such as diabetic peripheral neuropathic pain.

Asymmetric Atrophy of Multifidus Muscle in Patients With Unilateral Lumbosacral Radiculopathy

Prospective case-control study of multifidus muscle atrophy in 39 patients with unilateral lumbosacral radiculopathy and lumbosacral disc herniation and 20 controls. To evaluate quantitatively the asymmetry of multifidus muscles in unilateral lumbosacral radiculopathy with disc herniation (herniated intervertebral disc; HIVD) by using magnetic resonance imaging (MRI). Histologic and morphologic changes of multifidus muscles have been reported in lumbosacral disc herniation, but there are few imaging studies on the changes of multifidus muscles in unilateral radiculopathy. Bilateral multifidus muscles in L3-L4, L4-L5, and L5-S1 levels were detected in fast spin-echo T1 axial MRI images. The total cross-sectional area (CSA) of multifidus muscles (TMA) and the density of pure muscle CSA (PMA) were measured by a computerized analysis program, and the ratios of PMA to TMA (PMA/TMA) and the PMA ratios of involved to uninvolved sides (IMA/UMA) were calculated. The patients were divided into 2 groups according to the electrodiagnosis results: a radiculopathy (RAD) group and an HIVD group without definite radiculopathy. Fourteen patients had lumbosacral radiculopathies (RAD group) while 25 had no radiculopathy (HIVD group). No significant difference was found between the RAD and HIVD groups in TMA, PMA, and PMA/TMA. In terms of the criteria for the upper limit of IMA/UMA, 78.6% in the RAD group had an abnormal IMA/UMA ratio in at least 1 level, compared with 24% in the HIVD group and 10% in the control group. Thus, more cases with less muscle volume in the involved side were seen in the RAD group than in the HIVD and control groups. Asymmetry of the multifidus muscles as seen in MRI was a useful finding to assess patients who had unilateral lumbosacral radiculopathy with HIVD. This may reflect the denervation of multifidus muscles in lumbosacral radiculopathy.

Anterior Discectomy With Fusion And Stabilization For The Management Of Mono-Segmental Cervical Spondylotic Radiculopathy And Myelopathy

The purpose of the current study is to discuss the authors' experience and results in managing degenerative monosegmental cervical radiculopathy and myelopathy by anterior discectomy with fusion and stabilisation. This is a retrospective study which evaluates the results of anterior discectomy with fusion and stabilization performed between 1997 and 2004 at a tertiary-level health care institution. A Magnetic Resonance Imaging (MRI) scan was obtained in each case, and MRI depiction of a prolapsed cervical intervertebral disc was essential for inclusion in the study. Left-sided standard anterior cervical approach was used. Tricortical bone graft was impacted into the disc space, and stabilization was done using a standard anterior cervical H-type plate. Good to excellent results were seen in 87.95 % of patients in the radiculopathy group and 70.0 % of patients in the myelopathy group. Most of the complications were related to graft site morbidity. Non-union was seen in 3 of the patients.

EVALUATION OF CERVICAL RANGE OF MOTION IN A CERVICAL RADICULOPATHY PATIENT GROUP AND A MATCHED CONTROL GROUP USING THE SPIN-T GONIOMETER

Forty- six cervical radiculopathy patients, age- and gender-matched with 43 controls, recruited in this study were measured for end-range flexion, extension, lateral rotation right and left using the Spin-T goniometer. Within group differences were calculated using a paired t-test and differences between groups were compared using an independent sample t-test at p &lt; 0.05. The results showed that the mean cervical spine ROM in the cervical radiculopathy group was reduced compared to matched controls for flexion (t = 2.26, p = 0.02), extension (t = 2.30, p = 0.02) and full cycle rotation (sum of left and right rotation) (t = 2.01, p = 0.04). Differences calculated within normal controls and the patients for paired rotation movements were not significant. Cervical ROM comparisons between a cervical radiculopathy patient cohort and a normal control group indicate a trend toward limitation of ROM compared to normal controls although it does not seem to be a systematic feature of the pain population as tested in this study. The reduction was not unilaterally patterned and did not show any difference in individual movements of the cervical spine when compared to any one painful side.

Focal intense brief transcutaneous electric nerve stimulation for treatment of radicular and postthoracotomy pain

Carrol EN, Badura AS. Focal intense brief transcutaneous electric nerve stimulation for treatment of radicular and postthoracotomy pain. Arch Phys Med Rehabil 2001;82:262-4. Objective: To assess the efficacy of focal intense brief transcutaneous electric nerve stimulation in 2 groups of patients with neuropathic pain. Design: Electric stimulation was delivered with a small stylus electrode pressed against the skin paravertebrally in the radiculopathy group and along the surgical incision in the postthoracotomy neuralgia group. A before-after treatment design was conducted with a verbal pain rating scale. Setting: Outpatient multidisciplinary pain clinic at a Midwestern Veterans Affairs medical center. Participants: Fourteen consecutive patients with well-documented radiculopathy and 4 consecutive patients with postthoracotomy neuralgia. Results: Statistically significant differences were found in both patient groups, with posttreatment scores reflecting less pain than pretreatment scores for every patient. Conclusions: Patients reported reduced pain ratings following this stimulation technique. Further study of this inexpensive, noninvasive, outpatient technique is needed.

Magnetic stimulation in cervical radiculopathy and health controls

Magnetic stimulation was performed in 15 cases of unilateral cervical radiculopathy and 16 age-matched healthy controls. Among the muscle potentials which have acute slope and high amplitude, the difference between the minimal and the maximal latency in the same muscle was defined as variability. In the healthy control group, the variability of the muscle potentials evoked by head magnetic stimulation was approximately 2 ms. In cervical radiculopathy, the muscle potential latencies in head magnetic stimulation were normal except for one case because of the wide normal range. However, the interside difference of the muscle potential latency in head magnetic stimulation was significantly greater in the cervical radiculopathy group than in the healthy control group. This suggests that the interside difference of the muscle potential latency is more sensitive than the muscle potential latency in head magnetic stimulation in unilateral radiculopathy.

Adverse mechanical tension in the nervous system? Analysis of straight leg raise

The aim of this study was to investigate the effects of ankle dorsiflexion and cervical spine flexion on compliance of neural tissues to the straight leg raise (SLR) test in 20 normal subjects and 20 age and sex matched subjects with lumbar or sacral radiculopathy. Measures taken during SLR were SLR range at onset of resistance (R1) determined by an examiner, range of SLR at first increase in moment of the stretched tissues (M r ), and M r through range of SLR before and after onset of muscle activity (M1) recorded by electromyo-graphy. Results indicated that R1, although reliable, bares no correlation with measures of compliance and therefore has no discriminative power or validity. Ankle dorsiflexion and cervical spine flexion had insignificant effects on M r . However, M r was significantly greater in the radiculopathy group in SLR range post but not pre-M1. These results demonstrate normal compliance of neural tissue in subjects who present with adverse responses to, what has been referred to as, neural tension tests. We therefore recommend the term tension test be abandoned as it does not reflect the true nature of neural pathophysiology. Rather than R1 and through range resistance we suggest M1 more accurately represents increased neural mechanosensitivity and therefore clinically it is a more useful measure of neural pathophysiology.

頚髄後方除圧術後に生じた片側の神経根レベルでの麻ひ例の検討

In 3 patients cervical radiculopathy occurred after posterior decompression of the cervical spinal cord. In the postoperative radiculopathy group the average backward movement of the spinal cord was 4mm on the C5 level and 5mm on the C6 level. In the nonradiculopathy group the average backeward movement of the spinal cord was 2mm at the C5 and C6 level. We recommend wide laminoplastic enlargment of the cervical canal.