Neurophysiologic Changes After Preganglionic and Postganglionic Nerve-Root Constriction

Matsuda, Hideo; Tsai, Ching-Lin; Tseng, Chiu‐yu; Noriage, Akira; Tsai, Tse-Min; Dai, Yuan‐Chang; Jou, I‐Ming

doi:10.1097/01.brs.0000261030.97483.ac

Cited by 8 publications

(7 citation statements)

References 28 publications

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“…In addition, nerve structures involved in LS and CS are different. In LS, the dorsal root ganglia and their spinal nerves are involved, and injuring these structures caused much severer pain responses in an animal model compared with injury of dorsal roots in the central canal 9 – 13 . In summary, the relatively narrow anatomical structures and the nerve structures comprising the lumbar lateral canal may underpin the mechanism that explains why patients with symptomatic LS have more abnormal sensory test results and neuropathic pain.…”

Section: Discussionmentioning

confidence: 99%

“…In contrast to CS, LS involves the dorsal root ganglia and spinal nerves, which are more vulnerable to compression and produce more severe neuropathic pain 9 – 13 . Neuropathic pain is redefined as “pain arising as a direct consequence of a lesion or disease affecting the somatosensory system”; this redefinition was suggested by the International Association for the Study of Pain Special Interest Group on Neuropathic Pain in 2008.…”

Section: Introductionmentioning

confidence: 99%

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Diagnostic accuracy of standardised qualitative sensory test in the detection of lumbar lateral stenosis involving the L5 nerve root

Lin

Hsieh

Chen

et al. 2017

Sci Rep

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Misdiagnosis of symptomatic lumbar lateral stenosis (LS) may result in an unfavourable prognosis after surgical treatment. This study investigated the diagnostic accuracy of a standardised qualitative sensory test (SQST) in the detection of symptomatic LS in patients who had degenerative spinal disorders involving the L5 spinal nerve. We prospectively identified 75 patients, of which 60 met the inclusion criteria. Lateral recess stenosis at the L5 level or foraminal stenosis at the L5/S1 level on MRI was identified and graded by a neurosurgeon blinded to any clinical information. The reference criteria for the diagnosis of symptomatic LS were grade III LS on MRI and relevant clinical symptoms. Cutaneous sensory functions of the L5 dermatome on the symptomatic side were evaluated using the SQST. Each item of the SQST showed a satisfactory performance in the diagnosis of LS (sensitivity = 0.455–0.727, specificity = 0.868–1.0). A stepwise selection model identified low-strength von-Frey, high-strength von-Frey, and vibration as the most accurate predictors of symptomatic LS with an area under the receiver operating characteristic curve of 0.9563 (95% confidence interval = 0.9003–1.0). In combination with MRI, the SQST is a promising diagnostic tool for detecting symptomatic LS involving L5 nerve roots.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Diagnostic accuracy of standardised qualitative sensory test in the detection of lumbar lateral stenosis involving the L5 nerve root

Lin

Hsieh

Chen

et al. 2017

Sci Rep

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“…Future studies may evaluate the agreement of other MRI findings of different grades and preferably more functional MRI recordings (for example while standing, sitting and moving the spine) with pain drawing and physical examination findings indicating nerve involvement and also with other diagnostic methods of nerve involvement such as electrophysiological methods [72]. Larger and more homogeneous patient samples will add internal and external validity to these studies.…”

Section: Discussionmentioning

confidence: 99%

Assessment of nerve involvement in the lumbar spine: agreement between magnetic resonance imaging, physical examination and pain drawing findings

Bertilson

Brosjö

Billing

et al. 2010

BMC Musculoskelet Disord

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BackgroundDetection of nerve involvement originating in the spine is a primary concern in the assessment of spine symptoms. Magnetic resonance imaging (MRI) has become the diagnostic method of choice for this detection. However, the agreement between MRI and other diagnostic methods for detecting nerve involvement has not been fully evaluated. The aim of this diagnostic study was to evaluate the agreement between nerve involvement visible in MRI and findings of nerve involvement detected in a structured physical examination and a simplified pain drawing.MethodsSixty-one consecutive patients referred for MRI of the lumbar spine were - without knowledge of MRI findings - assessed for nerve involvement with a simplified pain drawing and a structured physical examination. Agreement between findings was calculated as overall agreement, the p value for McNemar's exact test, specificity, sensitivity, and positive and negative predictive values.ResultsMRI-visible nerve involvement was significantly less common than, and showed weak agreement with, physical examination and pain drawing findings of nerve involvement in corresponding body segments. In spine segment L4-5, where most findings of nerve involvement were detected, the mean sensitivity of MRI-visible nerve involvement to a positive neurological test in the physical examination ranged from 16-37%. The mean specificity of MRI-visible nerve involvement in the same segment ranged from 61-77%. Positive and negative predictive values of MRI-visible nerve involvement in segment L4-5 ranged from 22-78% and 28-56% respectively.ConclusionIn patients with long-standing nerve root symptoms referred for lumbar MRI, MRI-visible nerve involvement significantly underestimates the presence of nerve involvement detected by a physical examination and a pain drawing. A structured physical examination and a simplified pain drawing may reveal that many patients with "MRI-invisible" lumbar symptoms need treatment aimed at nerve involvement. Factors other than present MRI-visible nerve involvement may be responsible for findings of nerve involvement in the physical examination and the pain drawing.

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“…Animals with the constriction sites distal to the DRG presented more sensitive mechanical hyperalgesia than those with constriction sites proximal to the DRG [ 6 , 7 ]. In an electrophysiological study, compound actin potential of sensory nerves was significantly decreased 2 weeks after the injury in animals with the constriction sites distal to the DRG but not in those with constriction proximal to DRG [ 8 ]. The frequency and amplitude of the excitatory post-synaptic current in the dorsal horn were significantly increased in animals with the constriction distal to the DRG but not in those with the constriction proximal to the DRG [ 6 ].…”

Section: Introductionmentioning

confidence: 99%

ATF3-Expressing Large-Diameter Sensory Afferents at Acute Stage as Bio-Signatures of Persistent Pain Associated with Lumbar Radiculopathy

Lin

Chuang

et al. 2021

Cells

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The mechanism of pain chronicity is largely unknown in lumbar radiculopathy (LR). The anatomical location of nerve injury is one of the important factors associated with pain chronicity of LR. Accumulating evidence has shown constriction distal to the dorsal root ganglion (DRG) caused more severe radiculopathy than constriction proximal to the DRG; thereby, the mechanism of pain chronicity in LR could be revealed by comparing the differences in pathological changes of DRGs between nerve constriction distal and proximal to the DRG. Here, we used 2 rat models of LR with nerve constriction distal or proximal to the DRG to probe how the different nerve injury sites could differentially affect pain chronicity and the pathological changes of DRG neuron subpopulations. As expected, rats with nerve constriction distal to the DRG showed more persistent pain behaviors than those with nerve constriction proximal to the DRG in 50% paw withdraw threshold, weight-bearing test, and acetone test. One day after the operation, distal and proximal nerve constriction showed differential pathological changes of DRG. The ratios of activating transcription factor3 (ATF3)-positive DRG neurons were significantly higher in rats with nerve constriction distal to DRG than those with nerve constriction proximal to DRG. In subpopulation analysis, the ratios of ATF3-immunoreactivity (IR) in neurofilament heavy chain (NFH)-positive DRG neurons significantly increased in distal nerve constriction compared to proximal nerve constriction; although, both distal and proximal nerve constriction presented increased ratios of ATF3-IR in calcitonin gene-related peptide (CGRP)-positive DRG neurons. Moreover, the nerve constriction proximal to DRG caused more hypoxia than did that distal to DRG. Together, ATF3 expression in NHF-positive DRG neurons at the acute stage is a potential bio-signature of persistent pain in rat models of LR.

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Neurophysiologic Changes After Preganglionic and Postganglionic Nerve-Root Constriction

Cited by 8 publications

References 28 publications

Diagnostic accuracy of standardised qualitative sensory test in the detection of lumbar lateral stenosis involving the L5 nerve root

Diagnostic accuracy of standardised qualitative sensory test in the detection of lumbar lateral stenosis involving the L5 nerve root

Assessment of nerve involvement in the lumbar spine: agreement between magnetic resonance imaging, physical examination and pain drawing findings

ATF3-Expressing Large-Diameter Sensory Afferents at Acute Stage as Bio-Signatures of Persistent Pain Associated with Lumbar Radiculopathy

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