Lumbar Disc Disease With Amputated or Denervated Legs

Finney, Louis A.; Johns, Dale K.; Buermann, August

doi:10.1001/archneur.1964.00460170043007

Cited by 2 publications

(2 citation statements)

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“…7,8 Review of the cases described suggests that affected patients present with radicular pain, as early as 7 mos or as late as 40 yrs after amputation, often because of disc herniation at the L4-L5 or L5-S1 level. 4,[9][10][11] This case is unique in that this patient's phantom radiculopathy was secondary to extraforaminal nerve root compression by an osteophyte complex as compared with previously described cases. 4,9,10,12,13 Neurologic examination, nerve conduction studies, or electromyography of the affected limb in patients with amputation and radiculopathy is limited as one cannot assess for deficits in a dermatomal or myotomal pattern (Table 1).…”

Section: Discussionmentioning

confidence: 59%

“…Phantom sensation refers to the nonpainful perception that the amputated limb remains, whereas residual limb pain refers to amputation site pain 7,8 . Review of the cases described suggests that affected patients present with radicular pain, as early as 7 mos or as late as 40 yrs after amputation, often because of disc herniation at the L4–L5 or L5–S1 level 4,9–11 . This case is unique in that this patient’s phantom radiculopathy was secondary to extraforaminal nerve root compression by an osteophyte complex as compared with previously described cases 4,9,10,12,13 …”

Section: Discussionmentioning

confidence: 93%

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Radicular Pain After Hip Disarticulation

Philip

Sambasivan

2020

Am J Phys Med Rehabil

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A 36-yr-old man with a history of industrial accident causing traumatic left hip disarticulation, pubic symphysis, and right sacroiliac joint fractures presented with a 3-yr history of left-sided lower back pain radiating down the amputated limb. Computed tomography lumbar spine showed osteophytes surrounding the sacroiliac joint bilaterally with reduced left L4–L5 foraminal space. A fluoroscopically guided left sacroiliac steroid injection led to mild improvement in low back pain. Magnetic resonance imaging of the lumbar spine without contrast showed transitional type L5 vertebral body with left-sided flowing osteophytes abutting the extraforaminal L4 and L5 nerves. Ultimately, multilevel left fluoroscopically guided transforaminal epidural steroid injection at L4–L5 and L5–S1 significantly improved symptoms. Although phantom radiculopathy is a rare entity, clinical suspicion of degenerative spine disease or other pathology contributing to nerve impingement in patients with amputations should remain; this unique case discusses bony osteophyte complex as the cause for phantom radiculopathy instead of previously described disc herniation. Magnetic resonance imaging remains a key tool in delineating causes of low back pain among patients with lower limb amputations.

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