We used lumbar magnetic resonance image (MRI) findings to determine possible outcome predictors of a caudal epidural steroid injection (CESI) for radicular pain caused by a herniated lumbar disc (HLD).
Ninety-one patients with radicular pain whose MRI indicated a HLD were enrolled between September 2010 and July 2013. The CESIs were performed using ultrasound (US). A responder was defined as having complete relief or at least a 50% reduction of pain as assessed by the visual analog scale (VAS) and functional status on the Roland Morris Disability Questionnaire (RMDQ); responder (VAS n=61, RMDQ n=51), and non-responder (VAS n=30, RMDQ n=40). MRI findings were analyzed and compared between the two groups with regard to HLD level, HLD type (protrusion or exclusion), HLD zone (central, subarticular, foraminal, and extraforaminal), HLD volume (mild, moderate, or severe), relationship between HLD and nerve root (no contact, contact, displaced, or compressed), disc height loss (none, less than half, or more than half ), and disc degeneration grade (homogeneous disc structure or inhomogeneous disc structure-clear nucleus and height of intervertebral disc).
A centrally located herniated disc was more common in the responder group than that in the non-responder group. Treatment of centrally located herniated discs showed satisfactory results. (VAS p=0.025, RMDQ p=0.040). Other factors, such as HLD level, HLD type, HLD volume, relationship to nerve root, disc height loss, and disc degeneration grade, were not critical.
The HLD zone was significant for pain reduction after CESI. A centrally located herniated disc was a predictor of a good clinical outcome.
Citations
Method: Fourty-one patients with CP underwent MRI and SPECT of the brain. The patients were divided into 5 groups. Group 1 was for the cases with normal findings on MRI and SPECT, group 2 for abnormal on MRI but normal on SPECT, group 3 for normal on MRI but abnormal on SPECT, group 4 for abnormal findings on both MRI and SPECT with same abnormal lesion and group 5 for abnormal findings on both MRI and SPECT but with different abnormal lesion.
Results: In group 2, periventricular leukomalacia (PVL) and cortical atrophy were shown on MRI. In group 3, decreased blood flow at cerebellum was shown on SPECT. In group 4, brain atrophy on MRI and the decreased blood flow at the same site on SPECT were shown. In group 5, 15 of 22 cases with PVL on MRI and decreased blood flow at cerebellum, thalamus, basal ganglia and the cortical areas were shown.
Conclusion: Brain SPECT was more sensitive in the detection of cerebellum, thalamus and cortical blood flow abnormality. MRI was more sensitive in demonstration of white matter lesion. (J Korean Acad Rehab Med 2003; 27: 868-874)
Method: The subjects comprised 83 patients with CP. We analyzed the brain MRI findings such as periventricular leukomalacia (PVL), brain atrophy, infarction or hemorrhage, basal ganglia lesion, migration anomaly and delayed myelination with consideration of clinical subtypes of CP.
Results: Of the 83 MRI findings, 69 abnormalities (83.1%) were the followings; PVL in 47 cases{17 spastic diplegics (SD), 17 spastic quadriplegics (SQ), 5 spastic hemiplegics (SH), 4 atonic or hypotonic quadriplegics, 2 ataxic quadriplegics and 2 mixed quadriplegics (MQ)}, brain atrophy in 6 cases (3 SQ, 1 SD, 1 SH and 1 MQ), infarction or hemorrhage in 7 cases (5 SH and 2 SQ), migration anomaly in 2 cases (1 SQ and 1 SH), delayed myelination in 3 cases (2 SQ and 1 SH) and basal ganglia lesion in 4 cases (3 MQ and 1 atonic quadriplegic). 33 cases of 47 PVL and 2 cases of 6 brain atrophy were preterm CPs. There was no difference in severity of CP between preterm and fullterm CPs.
Conclusion: The results of this study would be helpful in estimating the brain lesions in various clinical subtypes of CP. (J Korean Acad Rehab Med 2003; 27: 862-867)
We present a case of 5th cervical spine (C5) body fracture following cervical spine manipulation. The patient was an 18 year-old girl. She visited a non-authorized manipulation practitioner because of her shoulder pain. At that time she had no neck pain. During manipulation, the practitioner turned her neck suddenly with strong force, then she felt sudden neck pain. A fracture of the C5 body was identified in magnetic resonance images of the cervical spine.
We should be aware of the risk of serious complications associated with chiropractic manipulation.
Objective: To investigate the correlation of multifidus muscle atrophy on MRI findings with clinical findings in low back pain patients.
Method: Medical records of 80 patients presenting with low back pain were retrospectively reviewed. Their MR images were visually analysed to know lumbar multifidus muscle atrophy, disc herniation, disc degeneration, spinal stenosis and nerve root compression.
Results: Multifidus muscle atrophy increased from the upper lumbar level to the most caudal intervertebral level. It was bilateral in the majority of the cases. Multifidus muscle atrophy was well correlated with patient's age, referred leg pain, and disc degeneration. However, duration of low back pain, disc herniation, spinal stenosis, nerve root compression, sex, weight, height and BMI had no correlation with multifidus muscle atrophy.
Conclusion: Examination of multifidus muscle atrophy should be considered when assessing MR images of lumbar spine. It may help for further evaluation and planning the treatment modalities of low back pain.
Electrophysiologic study including needle electromyograpy(EMG) was done in 66 patients with spina bifida who were referred to EMG laboratory. We have classified neurological impairments of spina bifida patients according to electrodiagnostic findings and the electrophysiologic study findings were compared with Magnetic Resonance Image(MRI) findings, and manual muscle test findings. Also electrophysiologic study findings were compared with urodynamic study(UDS) finding for the evaluation of neurogenic bladder in the same subjects.
55% of spina bifida patients had cauda equina lesions electrophysiologically and the most commonly involved, root was L5, and the next was S1. 42% of the subjects were normal electrophysiologically.
61% of patients with abnormal MRI findings had normal EMG findings. EMG findings did not correlated well with manual muscle tests in 44% of the subjects. Also in 44% of subjects, the electrophysiologic study was did not agree with urodynamic study findings.
In conclusion, we asserts that cauda equina lesion is a most common lesion in spina bifida patients and electrophysiologic study is superior than MRI or manual muscle test in detecting neurologic deficit of spina bifida patients. However, electrophysiologic study alone offers less accurate information than urodynamic study for the evaluation of neurogenic bladder in spina bifida patients.
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