Dermatomal somatosensory evoked potentials in the diagnosis of lumbosacral radiculopathies
Tóm tắt
The diagnostic sensitivity of dermatomal somatosensory evoked potentials (DSEPs) was evaluated in a homogeneous group of fifteen patients with low back pain due to isolated lumbosacral radiculopathy. The normative values from L3 to S1 were defined, as were the parameters of abnormality. In seven patients with pseudoradicular or referred leg pain, a negative neurological examination and images indicative of protrusion or paramedian disc hernia, the DSEPs were normal in six cases and slightly altered in one. In eight patients with deafferentiation leg pain, clinical signs of root damage and images indicative of an intraforaminal hernia, the DSEPs showed varying degrees of alteration which could generally be correlated to the severity of the clinical picture. This method can therefore be useful in differentiating pain due to stimulation of the receptors of the osteoarticular structures or the root sheath, in which the DSEPs are normal, from pain due to direct root damage, in which the DSEPs are altered. This functional evaluation of anatomical damage provides further information which may help to achieve a better therapeutic approach.
Tài liệu tham khảo
Aminoff M.J., Goodin S.D., Parry G.J. et al.:Electrophysiologic evaluation of lumbosacral radiculopathies: electromyography, and somatosensory evoked potentials. Neurology 35: 1514–1518, 1985.
Dvonch V., Scharff T., Bunch W.H. et al.:Dermatomal somatosensory evoked potentials: their use in lumbar radiculopathy. Spine 9: 291–293, 1984.
Eisen A., Elleker G.:Sensory nerve stimulation and evoked cerebral potentials. Neurology 30: 1097–1105, 1980.
Feinsod M., Blau D., Findler G., Hadani M., Beller A.J.:Somatosensory evoked potential to peroneal nerve stimulation in patients with herniated lumbar discs. Neurosurgery 11: 506–511, 1982.
Katifi H.A., Sedgwick E.M.,Somatosensory evoked potentials from posterior tibial nerve and lumbosacral dermatomes. Electroencephalogr. Clin. Neurophysiol. 65: 249–259, 1986.
Katifi H.A., Sedgwick E.M.:Evaluation of the dermatomal somatosensory evoked potential in the diagnosis of lumbo-sacral root compression. J. Neurol. Neurosurg. Psychiatry 50: 1204–1210, 1987.
Machida M., Asai T., Sato K., Toriyama S., Yamada T.:New approach for diagnosis in herniated lumbosacral disc. Dermatomal somatosensory evoked potentials (DSSEPs). Spine 11: 380–384, 1985.
Maureen C., Jensen M., Michael N. et al.:Magnetic resonance imaging of the lumbar spine in people without back pain. N. Engl. J. Med. 14: 69–73, 1994.
Perlik S., Fisher M.A., Patel D.V. et al.:On the usefulness of somatosensory evoked responses for the evaluation of low back pain. Arch. Neurol. 43: 907–913, 1986.
Pop P.H.M., Oepkes C.T., Notermans S.L.H., Stegeman D.F.:Dermatomal somatosensory evoked potentials of the lumbar and cervical roots. Eur. Arch. Neurol. Sci 238: 22–27, 1988.
Robertson J.T.:The rape of the spine. Surg. Neurol. 39: 5–12, 1993.
Rodriguez A.A., Kamis L., Rodriguez A.A., Lane D.:Somatosensory evoked potentials from dermatomal stimulation as an indicator of L5-S1 radiculopathy. Arch. Phys. Med. Rehabil. 68(6): 366–368, 1987.
Rydevik B., Brown M.D., Lundborg G.:Pathoanatomy and pathophysiology of nerve root compression. Spine 9: 7–15, 1984.
Slimp J.C., Rubner D.E., Snowden M.L., Stolov W.C.:Dermatomal somatosensory evoked potentials: cervical, thoracic, and lumbosacral levels. Electroenceph. Clin. Neurophysiol. 84: 55–70, 1992.
Scarff T.B., Dullmann D.E., Toleikis J.R.:Dermatomal somatosensory evoked potentials in the diagnosis of lumbar root entrapment. Surg. Forum 32: 489–491, 1981.
Sedgwick E.M., Katifi H.A., Docherty T.B., Nicpon K.:Dermatomal somatosensory evoked potentials in lumbar disc disease. In: Morocutti C. and Rizzo P.A. (Eds.), Evoked Potentials: Neurophysiological and Clinical Aspects. Elsevier, Amsterdam: 77–88, 1985.
Simmonds M., Kumar S.:The bases of low back pain. Neuro-Orthopedics 13: 1–14, 1992.
Tokuhashi Y., Kinyasati G., Funami S.:A quantitative evaluation of sensory dysfunction in lumbosacral radiculopathy. Spine 11: 1321–1328, 1991.
Van Akkerveeken P.F.:On pain patterns of patients with lumbar nerve root entrapment. Neuro-Orthopedics 14: 81–102, 1993.
Wilbourn J., Aminoff M.J.:AAEE Minimonograph 32: the electrophysiologic examination in patients with radiculopathies. Muscle Nerve 11: 1099–1114, 1988.
Yoshizawa H., Kobayashi S., Kubota K.:Effects of compression on intradraadicular blood flow in dogs. Spine 14: 1220–1225, 1989.