• Journal of Korean Neurosurgical Society
• /
• v.51 no.5
• /
• pp.286-291
• /
• 2012

Objective : To investigate the change of latency of cervical dermatomal somatosensory evoked potential (DSEP) according to stimulation intensity (SI) and severity of carpal tunnel syndrome (CTS). Methods : Stimulation sites were the C6, C7, and C8 dermatomal areas. Two stimulation intensities $1.5{\times}$sensory threshold (ST) and $2.5{\times}ST$ were used on both normal and CTS patients. Results : In moderate CTS, the latencies of C6 and C7 DSEP during $1.5{\times}ST$ SI and those of C7 DSEP during $2.5{\times}ST$ SI were significantly delayed compared with the values of normal subjects. Significant correlation between the latency of C7 DSEP of $2.5{\times}ST$ stimulation and the median sensory nerve conduction velocity was observed. Conclusion : We suggest that these data can aid in the diagnosis of cervical sensory radiculopathy using low stimulation intensity and of those who have cervical sensory radiculopathy combined with CTS patients.

• The Korean Journal of Pain
• /
• v.14 no.1
• /
• pp.104-109
• /
• 2001

We describe the accidental injection of local anesthetics containing steroid into the subdural space during an attempted lumbar epidural injection for intractable radiculopathy in a patient with failed back surgery syndrome. A 24-year-old man complained of severe radiating pain to left lower extremity and showed a walking disturbance and severe lumbar scoliosis. The MRI finding was a left paramedian recurred disc herniation on L4-5 in a laminectomy state. Several therapeutic modalities such as epidural steroid injection, transforaminal injection, L2 root block, medication, and exercise therapy, etc failed. Initially, during epidural block at L4-5 under fluoroscopic guidance, a railroad track appearance appeared on epidurogram suggesting the presence of a subdural space. A second epidural block was tried at L5-S1. Following confirmation of epidural space upon epidurogram, 6 ml of 0.5% lidocaine including triamcinolone 40 mg was injected. The patient showed signs of the subdural injection including an unexpectedly high sensory block (T2) and a motor weakness of both lower extremities. Following this event, the severe radiculopathy and lumbar scoliosis were improved. Therefore, we conclude that subdural injection of steroid could be helpful in intractable radiculopathy, especially in the failed back surgery syndrome. However, it must be used cautiously with careful patient selection.

• Journal of Acupuncture Research
• /
• v.18 no.6
• /
• pp.59-69
• /
• 2001

Objective : The aim of this study is to assess the ability of the CPT test to dignosis radiculopathy in Korean with NeuvalTM CPT database. Method : Electrical stimulation(at 2000, 250, and 5Hz) using Neurometer was applied to the 19 patients who felt back and sciatic pain with herniated intervertevral disc(HIVD) of L-spine, dignosisd by lumbar CT or MRI, and the 33 patients who felt only back or hip or leg pain without HIVD, stenosis, spondylolisthesis which causing radiculopathy. The test sites were toe1, toe3 and toe5 related to L4, L5 and S1 nerve roots. Results : The mean values of the CPT of HIVD group was stiatically lower than LBP group at toe1-250Hz, toe3-2000Hz, 250Hz and toe5-250Hz, 5Hz. The grading CPT score of HIVD group was stastically higher than LBP group at the toe3(L5). The VAS of HIVD group was stastically higher than LBP group. Conclusion : These results suggest that the CPT test can be a valuable testing for diagnosing radiculopathy in Korean. In using CPT test further study is needed for the diagnosis and evaluation of sensory nerve dysfunction in the musculoskeletal disease.

• The Journal of Korean Physical Therapy
• /
• v.14 no.4
• /
• pp.64-74
• /
• 2002

The SSEP(SomatoSensory Evoke Potentials) test is a valid and repeatable technique which correlates with clinically assessed joint position & vibration sense, skin touch & pressure sense. Also SSEP study is a simple and quantitative test, and has been used to evaluate the sensoty system along the somatosensory pathway from peripheral sensory receptor to the cortex. The ascending pathway of SSEP has been know to be posterior column-lemniscal pathway, but not without controversy. There are two kind of test mathods : one of test is median nerve SSEP and other test is posterior tibial nerve SSEP. Recently, SSEP used to performed to evaluate the usefulness of dermatomal SSEP(D-SSEP) and segmental SSEP(5-SSEP) for the diagnosis of lumbasacral radiculopathy, and it can be measure of ingual ahd palatine evoked potentials & indicator of medullary function useful for the diagnosis of brain death.

• Annals of Clinical Neurophysiology
• /
• v.3 no.1
• /
• pp.15-20
• /
• 2001

Background : Carpal tunnel syndrome(CTS) is the most common entrapment neuropathy that refers to a group of signs and symptoms resulting from compression of the median nerve at the wrist. The course of CTS in older patients is different from the younger patients. This difference may be the result of different underlying mechanisms. The different nerve conduction studies of CTS may signify different approaches in management. This study was done to assess the differences in nerve conduction study of CTS in younger and older patients. Methods : This study involved 224 patients who visited Gachon Medical School, Gil Medical Center and was diagnosed by nerve conduction study from October 1997 to October 1999. We compared the results of nerve conduction study to age, especially in between those under 60 years and those 60 years or over CTS patients. Nerve conduction study consists of motor studies of both median nerves(terminal latency, compound action potential) and sensory studies(nerve conduction velocity, nerve action potential). And we also evaluated the variables between younger and older patients group. Those variables include sex, symptom period, laterality, abnormal physical findings and radiculopathy. Results : We found that a significant increase of terminal latency(p<0.1), but a decrease in compound motor action potential(p<0.05) in older patient's group. There was no significant differences in sensory nerve conduction velocity and action potential between those under 60 years and those 60 years or even patients. And also there was no significant difference in sex, symptom period, laterality, abnormal physical findings, radiculopathy between older and younger patients. Conclusions : This study showed a significant increase in the terminal latency and a decrease in compound action potential in older patients. The different nerve conduction studies of CTS by age effect may need different approaches in management.

• The Korean Journal of Pain
• /
• v.22 no.2
• /
• pp.181-185
• /
• 2009

Herpes zoster is a viral disease of the posterior root ganglion and sensory nerve fiber, which presents clinically with vesicular eruption of the skin, radicular pain and sensory changes in the distribution of the affected ganglion. However, involvement of the motor neurons can be seen as well. If classic cutaneous lesions are present, herpes zoster-related motor paresis is easily diagnosed. Otherwise, the diagnosis may be more difficult and suspicious, especially if weakness occurs as a symptom before cutaneous lesions appear, or abnormal findings on the MRI are consistent with the signs. There have been few reports of sciatica with motor loss preceding skin lesions. Here, we report a patient with herpes zoster-related motor paresis preceding skin lesions. In the preliminary diagnosis, the herpes zoster-related motor paresis was confused for some structural disorder.

• Journal of Korean Neurosurgical Society
• /
• v.41 no.3
• /
• pp.207-209
• /
• 2007

We present an elderly patient with unilateral foraminal stenosis treated by isthmus resection. An 83-year-old female could not walk due to severe leg pain along right L5 sensory dermatome. Despite the laminotomy for spinal stenosis on the right side at the L4-5 level, her leg pain did not improve. Careful review of computed tomography scans and coronal source images of magnetic resonance myelography revealed foraminal stenosis on the right side at the L5 vertebra. Because of medical problem, she underwent isthmus resection on the right side at the L5 level instead of total facetectomy and fusion. After surgery, her leg pain was markedly improved. Isthmus resection showed successful result for this medically compromised elderly patient with unilateral foraminal stenosis.

• Journal of Korean Neurosurgical Society
• /
• v.58 no.5
• /
• pp.483-486
• /
• 2015

Cervical epidural steroid injection is frequently used in the conservative management of neck pain and cervical radiculopathy. Epidural cervical transforaminal injections are usually well-tolerated with mild side effects such as transient decreased sensory and motor function, or headache due to dural puncture. Although there are a few case reports about adverse effects of cervical epidural injection in the literature, it can cause severe complications such as large hematoma, infarction by spinal vascular injury. Subdural hematoma has been occurred much less common rather than epidural hematoma in the spinal cord. We report a rare catastrophic case of cervical spinal subdural hematoma with quadriparesis after cervical transforaminal epidural block.

• Journal of the Korean Society of Radiology
• /
• v.82 no.6
• /
• pp.1628-1633
• /
• 2021

Spinal epidural arteriovenous fistulas (SEDAVFs) are rare spinal vascular malformations that are difficult to diagnose and treat. SEDAVFs can be asymptomatic; however, symptoms can arise from the compression of adjacent nerve roots by dilated vein and perimedullary venous reflux, caused by shunting into the epidural venous plexus. A 31-year-old male presented to our institution with a 2-year history of progressively worsening low-back pain, radiating thigh pain, and sensory changes in his lower extremities. MRI and CT angiography demonstrated dilated epidural vascular lesion compressing the nerve root. The SEDAVF was embolized with multiple coils, which alleviated the nerve root compression from the engorged venous varix and improved the patient's radiculopathy. Our experience from this case shows that endovascular coil embolization using the transarterial approach can be an effective treatment for SEDAVF and an alternative to surgical ligations.

• Journal of Korean Neurosurgical Society
• /
• v.29 no.10
• /
• pp.1377-1382
• /
• 2000

Ossification of ligamentum flavum(OLF) is a type of ectopic bone formation developed within the spinal ligament. Thoracic myelopathy is common symptom of OLF but radiculopathy is uncommon. We present 3 operated cases of OLF. Two showed myelopathy and one radiculomyelopathy. Main symptoms were motor weakness, sensory disturbance, incoordination of both legs, and back pain. One patient complained of left girdle pain in T4 dermatome. Deep tendon reflex(DTR) was increased in all cases. The diagnosis was made from myelogram, CT and MRI. Sufficient posterior decompressive laminectomy and medial facetectomy were performed. Postoperative diagnosis was comfirmed by histopathological examination. One patient could return to work 3 months after operation and two patients showed satisfactory improvement 2-3 months after operation. Early diagnosis and appropriate surgical treatment were prerequisite of good outcome.