• Clinical Pain
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• v.19 no.2
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• pp.90-96
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• 2020

Objective: To investigate the diagnostic accuracy of two physical examinations (straight leg raise [SLR] and Bragard test) and electromyography (EMG) in patients with lumbosacral monoradiculopathy in acute and chronic state on confirmation of different diagnostic criteria (MRI vs MRI and diagnostic selective nerve root block [DSNRB]). Method: We identified 297 participants retrospectively from the departmental database. MRI evidence of L5 or S1 nerve root compression and a positive result in diagnostic SNRB served as reference standards. They were divided into two groups by the symptom duration: lasting more than 12 weeks in the chronic group and less than 12 weeks in the acute group. The diagnostic value of clinical tests and EMG were compared. Results: The clinical tests (SLR and Bragard test) done in acute stage on detection by MRI and DSNRB had the highest sensitivity (68%) compared to the chronic stage (63%), but sensitivity was low (57%) on confirmation of MRI alone. However, there was no significant difference on sensitivity and specificity of EMG regardless of reference standards and symptom duration. Electromyography was a significant predictor of neuropathic abnormalities on both acute (OR, 6.3; 95% CI, 2.4 to 16.7; p<0.01) and chronic (OR, 6.8; 95% CI, 2.9 to 16.3; p<0.01). Conclusion: In general, individual physical tests are easy to do and a combination of those tests could be a sensitive indicator of L5 or S1 radiculopathy. Furthermore, the use of provocation tests could provide useful information, especially in proceeding therapeutic selective nerve root block.

• Journal of Digital Convergence
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• v.11 no.8
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• pp.243-250
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• 2013

The present study is to determine the effect of lumbosacral stabilization exercise program on back pain disorder and gait velocity of patients with chronic low back pain. The subject was extracted randomly from 34 patients with chronic low back pain and divided into 18 patients of experimental group and 16 patients of control group. Before the experiment, the Oswestry disability index examination and analysis of gait speed were performed. Then, a conventional interventional therapy of physiotherapy was performed with the experimental group along with the lumbosacral stabilization exercise while only the conventional interventional therapy was done to the control group. Both groups did the above treatment every 30 minutes, four times a week for four weeks. Then, post-examination was carried out followed by comparing the back pain disorder index and gait velocity before and after the experiment for the two groups. The back pain disorder index showed that both experimental and control groups had significant difference within the group (p>.01)(p>.05), With regard to the gait velocity, both experimental and control groups had a significant difference within the experimental group and between the groups (p>.001)(p>.05).

• Journal of Korean Neurosurgical Society
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• v.56 no.6
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• pp.517-520
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• 2014

Cauda equina syndrome (CES) associated with dural ectasia is a rare neurologic complication in patients with longstanding ankylosing spondylitis (AS). We report a 68-year-old male with a 30-year history of AS who presented a typical symptom and signs of progressive CES, urinary incontinence and neuropathic pain of the lumbosacral radiculopathy. Computed tomography (CT) and magnetic resonance imaging (MRI) findings showed the unique appearances of dural ectasia, multiple dural diverticula, erosion of posterior element of the lumbar spine, tethering of the conus medullaris and adhesion of the lumbosacral nerve roots to the posterior aspect of the dural ectasia. Considering the progressive worsening of the clinical signs, detethering of the conus medullaris through resection of the filum terminale was performed through a limited laminectomy. However, the urinary incontinence did not improve and there was a partial relief of the neuropathic leg pain only. The possible pathogenetic mechanism of CES-AS and the dural ectasia in this patient with longstanding AS are discussed with a literature review.

• The Korean Journal of Pain
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• v.19 no.1
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• pp.101-103
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• 2006

Oral prostaglandin E1 (PGE1) is a medicine that is clinically applied during a treatment of patients suffering with vascular disease with chronic arterial obstruction because it has vasodilation and anti-platelet effects. The mechanisms of lumbosacral symptoms associated with spinal stenosis probably include vascular insufficiency with hypoxic injury to the cauda equina and the nerve roots. Thus, increasing the blood supply would be beneficial to improve the pathophysiologic condition. Several studies on the improvement of clinical symptoms of spinal stenosis by PGE1 treatment have been reported on. In this case, 47-year old female underwent posterior compression and posterolateral fusion with a cage at L2-4 due to L3 compression fracture, and she did not show improvement of the radiating pain of her right leg after the operation. Therefore, she received repetitive epidural catheterization and adhesiolysis, epidural block and physical therapy, but her symptoms deteriorated after temporary improvement. Finally, she was given PGE1 and the radiculopathy was completely improved, although some muscle weakness still remained.

• YAKHAK HOEJI
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• v.35 no.6
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• pp.486-496
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• 1991

Spinal parasympathetic outflows originate in the sacral parasympathetic nuclei. The sacral parasympathetic nuclei receive inputs from the brainstem. Many areas in the medulla appear to influence sympathetic outflow of the spinal cord. Whether neurons in these areas of the medulla may project to the lumbosacral cord to affect the parasympathetic outflow has not been studied clearly. Thus, this study was intended to investigate origins of cells projecting from the medulla to the sacral parasympathetic nuclei of the spinal cord. In 3 cats, horseradish peroxidase (HRP) was injected into the lower lumbar spinal cord. HRP labeled neurons were found mainly in the following areas: nucleus retroambiguus, nucleus tractus solitarius, raphe complex and ventrolateral area of the rostral medulla. Most of these areas are known to be involved in regulation of sympathetic activity, and, thus, these results indicate that these areas are likely to affect the sacral parasympathetic outflow as they do for the sympathetic nerves.

• Journal of Korean Medicine Rehabilitation
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• v.21 no.1
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• pp.115-123
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• 2011

Objectives : This study was designed to investigate the correlation coefficients among Oswestry low-back pain disability index(ODI), Roland-Morris disability questionnaire (RMD), visual analogue scale(VAS), lumbar lordosis angle(LLA), Cobb's angle and Ferguson's angle(FA). Methods : We measured LLA, Cobb's angle, and FA of 42 students. Then we researched ODI, RMD and VAS of all students, and analyzed correlations coefficient among all of them. Results : 1. There was significant correlation among VAS, RMD, ODI. 2. There was significant correlation between ODI and Cobb's angle. 3. There was no significant correlation between LLA, FA, Cobb's angle and VAS. 4. There was no significant correlation among LLA, FA, Cobb's angle and RMD. Conclusions : According to above results, there was no significant correlation between lumbosacral balance and low back pain except between ODI and Cobb's angle. On the other hand, there was significant correlation among RMD, ODI and VAS.

• Journal of Korean Institute of Industrial Engineers
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• v.21 no.4
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• pp.581-591
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• 1995

The main objective of this study is to compare three representative methods predicting compressive forces on lumbosacral disc : LP-based method, double LP-based method and EMG-assisted method. Two subjects simulated lifting tasks performed in the refractories industry, in which vertical and horizontal distance, and weight of load were varied. To calculate the L5/S1 compressive forces, EMG signals from six trunk muscles were measured and postural data and locations of load were recorded using the Motion Analysis System. The EMG-assisted model was shown to reflect well all three factors considered here. On the other hand, the compressive forces of the LP-based model and the double LP-based model were only significantly affected by weight of load. In addition, lowly positive correlation was observed between compressive forces of the EMG-assisted model and lifting index(LI) of 1991 NIOSH lifting equation. From this results, it can be concluded that compressive forces on L5/S1 by the EMG-assisted method should be used as biomechanical criterion in order to evaluate risk of jobs precisely, and LI can not evaluate risk of lifting tasks fully.

• The Korean Journal of Pain
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• v.26 no.2
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• pp.203-206
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• 2013

There have been reports of abnormalities in the lumbosacral region involving a lower-than-normal termination of the dural sac, which is caused by disease or anatomical variation. Inadvertent dural puncture or other unexpected complications can occur during caudal epidural block or adhesiolysis in patients with these variations, but only a small number of case reports have described this issue. We report a case of dural puncture by the introducer needle before attempting caudal epidural adhesiolysis, which occurred even though the needle was not advanced upward after penetrating the sacrococcygeal ligament. Dural puncture was caused by a morphological abnormality in the lumbosacral region, with no pathological condition; the dural sac terminal was located more distally than normal. However, dural puncture could have been prevented if we had checked for such an abnormality in the magnetic resonance imaging (MRI) taken before the procedure.

• Journal of the Korean Society of Physical Medicine
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• v.14 no.2
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• pp.21-28
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• 2019

PURPOSE: This study was conducted to compare different standing postures with the use of standing aids for lumbar spine posture and muscle activity, and to identify the most desirable standing posture. METHODS: The lumbopelvic angle was assessed based on static radiographic measurement on the sagittal plane. Lumbar lordosis, lumbosacral lordosis, and the intervertebral joint angle at L1/L5 and L5/S1 were measured using radiography in three standing postures (standing on level ground, standing with one foot on a platform, and standing on a sloped surface). In addition, muscle activity was measured using surface electromyography to examine the co-contraction of the lumbar and hip muscles. RESULTS: Lumbar lordosis, lumbosacral lordosis, and L5/S1 intervertebral joint flexion occurred with one foot on the platform. No significant differences were found between standing on a sloped surface and standing on level ground. However, muscle co-contraction was reduced with the use of standing aids. CONCLUSION: This study demonstrated that standing with a foot on a platform induced lumbar lordosis, but that there was no significant difference between standing on a sloped surface and standing on level ground. However, muscle co-contraction was reduced with the use of standing aids. Based on the motor control pattern as a predictor of LBP, the use of standing aids would help workers during prolonged standing.

• Journal of Korean Neurosurgical Society
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• v.64 no.2
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• pp.143-150
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• 2021

Spinal dysraphism often causes neurological impairment from direct involvement of lesions or from cord tethering. The conus medullaris and lumbosacral roots are most vulnerable. Surgical intervention such as untethering surgery is indicated to minimize or prevent further neurological deficits. Because untethering surgery itself imposes risk of neural injury, intraoperative neurophysiological monitoring (IONM) is indicated to help surgeons to be guided during surgery and to improve functional outcome. Monitoring of electromyography (EMG), motor evoked potential, and bulbocavernosus reflex (BCR) is essential modalities in IONM for untethering. Sensory evoked potential can be also employed to further interpretation. In specific, free-running EMG and triggered EMG is of most utility to identify lumbosacral roots within the field of surgery and filum terminale or non-functioning cord can be also confirmed by absence of responses at higher intensity of stimulation. The sacral nervous system should be vigilantly monitored as pathophysiology of tethered cord syndrome affects the sacral function most and earliest. BCR monitoring can be readily applicable for sacral monitoring and has been shown to be useful for prediction of postoperative sacral dysfunction. Further research is guaranteed because current IONM methodology in spinal dysraphism is still deficient of quantitative and objective evaluation and fails to directly measure the sacral autonomic nervous system.