BACKGROUND AND PURPOSE: Electrodiagnostic studies can be used to confirm the diagnosis of lumbosacral radiculopathies, but more sensitive diagnostic methods are often needed to measure the ensuing motor neuronal loss and sympathetic failure. METHODS: Twenty-six patients with lumbar radiculopathy and 30 controls were investigated using nerve conduction studies, motor unit number estimation (MUNE), testing of the sympathetic skin response (SSR), quantitative electromyography (QEMG), and magnetic resonance myelography (MRM). RESULTS: Using QEMG as the gold standard, the sensitivity and specificity of MUNE for the abductor hallucis longus muscle were 71.4% and 70%, respectively. While they were 75% and 68.8%, respectively, when used MRM as gold standard. The sensitivity and specificity of MUNE for the extensor digitorum brevis muscle were 100% and 84.1%, respectively, when the peroneal motor amplitude as the gold standard. The SSR latency was slightly longer in the patients than in the controls. CONCLUSIONS: MUNE is a simple and sensitive test for evaluating autonomic function and for diagnosing lumbosacral radiculopathy in patients. MUNE could be used routinely as a guide for the rehabilitation of patients with radiculopathies. SSR measurements may reveal subtle sympathetic abnormalities in patients with lumbosacral radiculopathy.
Axons* ; Diagnosis ; Electromyography ; Humans ; Methods ; Motor Neurons ; Muscles ; Myelography ; Neural Conduction ; Radiculopathy* ; Rehabilitation ; Sensitivity and Specificity ; Skin*

PURPOSE: A comparison of MRI and computed tomography-myelography (CTM) for lumbar intracanalar dimensions. To compare the capability and reproducibility of MRI and CTM in measuring the cross-sectional morphology of intracanalar lesions of the lumbar spine. MATERIALS AND METHODS: MRI and CTM of lumbar disc levels from 61 subjects with various lumbar spinal diseases were studied. Dural area, dural anteroposterior (AP) diameter, dural right-left diameter, and thickness of the ligamentum flavum were measured by two orthopedic surgeons. Each section was graded by degree of stenosis. Absolute value and intra- and inter-observer correlation coefficients (ICC) of these measurements and the associations between MRI and CTM values were determined. RESULTS: Except for MRI determination of ligament flavum thickness, CTM and MRI and intra- and ICC suggested sufficient reproducibility. When measurements of dural area, dural AP diameter, and RL diameter were compared, values in CTM were significantly (p = 0.01-0.004) larger than those in MRI (CTM/MRI ratios, 119%, 111%, and 105%, respectively). As spinal stenosis became more severe, discrepancies between CTM and MRI in measurements of the dural sac became larger. CONCLUSION: Both CTM and MRI provided reproducible measurements of lumbar intracanalar dimensions. However, flavum thickness may be more accurately measured by CTM. Because the differences in the measurements between CTM and MRI are very slight and there is very little data to suggest that the precise degree of stenosis is related to symptoms or treatment outcome, the usefulness of the CTM over MRI needs to be confirmed in future studies.
Aged ; Aged, 80 and over ; Female ; Humans ; Lumbar Vertebrae/*pathology/*radiography ; Magnetic Resonance Imaging/*methods ; Male ; Middle Aged ; Myelography/*methods ; Spinal Stenosis/*pathology/*radiography ; Tomography, X-Ray Computed/*methods

A non-ambulatory dog with tetraparesis following a pain episode that had evolved over 2 months was submitted for medical treatment and diagnosed with intervertebral disk disease at C3-C4 and dorsal extradural compression at C1-C2 and C3-C4 using myelography and computed tomography. The dog experienced ambulation recovery after 15 days of treatment with only electroacupuncture and Chinese herbal medicine, with marked improvement occurring after only 10 treatments. Six months of followup demonstrated that the dog was stable and had no recurrence of symptoms. Therefore, it was concluded that the combination of electroacupuncture and Chinese herbal medicine was responsible for motor rehabilitation.
Animals ; Cervical Vertebrae/*pathology ; Dog Diseases/*drug therapy/*therapy ; Dogs ; Drugs, Chinese Herbal/*therapeutic use ; Electroacupuncture/methods/*veterinary ; *Intervertebral Disk ; Myelography/veterinary ; Spinal Cord Compression/radiography/therapy/*veterinary ; Spinal Diseases/drug therapy/therapy/*veterinary ; Treatment Outcome

OBJECTIVETo investigate the corrective results of congenital scoliosis with type II split spinal cord malformation.

METHODSBy reviewing the medical records and roentgenograms of congenital scoliosis patients with type II split spinal cord malformation that underwent corrective surgery, septum location and length, curve type, coronal and sagittal Cobb's angles, apical vertebral rotation and translation, and trunk shift were measured and analyzed.

RESULTSA total of 23 congenital scoliosis patients with type II split spinal cord malformation were studied, 6 cases were due to failure of segmentation, 8 cases due to failure of formation, and the remaining 9 cases due to mixed defects. The fibrous septums were located in the thoracic spine in 8 patients, lumbar spine in 4 patients, thoracic and lumbar spine in 10 patients, and from cervical to lumbar spine in 1 patient The septum extended an average of 4.9 segments. Corrective surgeries included anterior correction with instrumentation in 2 patients, posterior correction with instrumentation in 11 patients, anterior release and posterior correction with instrumentation in 6 patients, anterior and posterior resection of the hemivertebra and posterior correction with instrumentation in 4 patients. The pre- and postoperative coronal Cobb's angles, apical vertebral translations, apical vertebral rotations, trunk shifts were 61.9 degrees and 32.5 degrees (P < 0.001), 48.9 mm and 31.5 mm (P < 0.001), 1.2 and 1.1, 12.7 mm and 8.2 mm, respectively. The average correction rate of coronal Cobb's angle was 47.5%. The sagittal balance was also well improved. The fibrous septums were all left in situ. There was no neurological complication.

CONCLUSIONFor congenital scoliosis with type II split spinal cord malformation, positive correction results with no neurological complication may be obtained without resection of the fibrous septum.

Adolescent ; Adult ; Child ; Female ; Follow-Up Studies ; Humans ; Magnetic Resonance Imaging ; Male ; Myelography ; methods ; Retrospective Studies ; Scoliosis ; congenital ; diagnostic imaging ; surgery ; Spinal Cord ; abnormalities ; diagnostic imaging ; surgery ; Treatment Outcome

One hundred and fourteen cases of lumbar herniated nucleus pulposus were studied retrospectively. I reviewed the clinical records and radiographs of patients treated with diskectomy and anterior interbody fusion. I followed the patients from 2 years up to 15 years, for an average of 2.9 years. The results were calculated statistically by Fisher exact test and Chi-square test. Among 114 patients, 69 patients (60.5%) were male and 45 patients (39.5%) were female. The most common age group was in its twenties (28.1%), while the whole study group ranged from 19 to 65 years. The most commonly involved level was L4-5 (73 cases, 60.4%). In clinical results, 83.3% of cases were excellent or good. The rate of solid fusion was 87.8%. The most common type of fusing pattern was type 1. The satisfying clinical result had statistical correlation with the solid union of grafted bone and the fusion state of maintained intervertebral disk height, respectively, by Fisher exact test (p < 0.001). The affecting factors in clinical results were the solid fusion and fusion with the state of maintenance of intervertebral disk height (fusing pattern type I and II). I concluded that anterior diskectomy and interbody fusion is a recommendable method of treatment for lumbar herniated nucleus pulposus.
Adult ; Aged ; Female ; Human ; Intervertebral Disk Displacement/surgery* ; Intervertebral Disk Displacement/radiography ; Lumbar Vertebrae/surgery* ; Lumbar Vertebrae/radiography ; Male ; Middle Age ; Myelography ; Postoperative Complications ; Retrospective Studies ; Spinal Fusion/methods* ; Treatment Outcome

Lumbar spinal stenosis may be defined as any type of narrowing of the spinal canal, nerve root canals or intervertebral foramina. It may be local, segmental or generalized and may be caused by the encroachment of bone or soft tissue. The narrowing may involve the bony canal alone or the dural sac or both. Myelo-enhanced computerized tomography(MECT) has been accepted as especially useful diagnostic method for spinal steonsis after its application in the orthopedic fields. The goal of this study was to analyze the diagnostic accuracy and sensitivity of MECT and to determine the prevalance of stenosis in various regions of lumbar spine. During the period of 3 years, from January 1991 to December 1993, 40 cases of lumbar spinal stenosis were analyzed, all of whom took myelography, computerized tomography and surgical treatment. The results of the study were as follows: 1. The myelographic findings were, respectively, hourglass bilateral defect 15(37.5%), complete block 14(35%) and the unilateral focal defect 5(12.5%). 2. The most prevalent from of spinal stenosis was the combined central-lateral-foraminal stenosis(47.5%) and the degenerative change in the lumbar spine was the principal etiologic factor(55%) by Arnoldi classification. 3. The involved levels were as follows:1 level 18(45%), 2 level 16(40%) and 3 level 6(15%). And among single level, the most frequent level was L5-S1 intervertebral space(30%). The diagnostic accuracies according to operative finding and above results were 83% by myelography and 97.5% by MECT. The MECT showed absolutely superior to myelography or CT and it was especially useful in lateral stenosis and multi-level stenosis.
Classification ; Constriction, Pathologic ; Dental Pulp Cavity ; Methods ; Myelography ; Orthopedics ; Spinal Canal ; Spinal Stenosis ; Spine

Intramedullary spinal neurofibroma is extremely rare. A case of cervical intramedullary neurofibroma is presented in a 21-year-old man. Only 20 case have been previously reported in the literature. The site of origin is discussed with various hypotheses.
Adult ; Humans ; Male ; Myelography/methods ; Neck ; Neurofibroma/*pathology/radiography ; Spinal Cord Neoplasms/*pathology/radiography ; Tomography, X-Ray Computed

During the period from January 1980 to September 1988, 59 patients suffering from brachial plexus injury, have admitted to Seoul National University Hospital. Fifty-four patients were male and 5 patients were female, and age ranged from 6 to 58 years (mean:26.8 years). The most common cause of injury was traffic accident accounting for 66% (39patient), and among them 24 patients(62%) had the motor cycle accident. Birth injury, stab or gun shot wound, fall down and industrial hazard were following causes. Fracture and dislocation of involved limb accompanied in 19 patients(32%) and 2 patients of arterial injury were also found. EMG and cervicsl myelography with or without CT were performed in almost all the patients and MRI was performed in selected patients. Forty-five patients(76%) had supra-clavicular lesion and 14 patients (24%) had infra-clavicular lesion. In supra-clavicular lesion, upper roots or whole roots were involved in most of cases. Forty-nine cases were treated with conservative treatment for more than 8 months and operative procedures were performed in 36 cases. In operative cases, 30 patients were followed up for more than 1 year (average 24.3 months). Signs of root avulsion were found in 25 out of 31 cases of cervical myelography. MRI was performed in 7 cases, but it was inconclusive in diagnosis of root involvement. Infra-clavicular lesion showed better prognosis than supra-clavicular lesion. In supra-clavicular lesion, upper root involvement had the best prognosis. A pseudocyst detected by myelography usually precluded recovery in the root at the level of pseudocyst. Result of reparative treatment was better than that of conservative treatment. Overall satisfactory result in reparative treatment was 36%. However, if we include neurological improvement, positive result was 53%. Complete recovery was gained in half cases of neurolysis and other half showed no recovery, but all the cases of neurotization showed poor result. Reconstructive surgery including arthrodesis or muscle transfer can be effective treatment method, if it is performed properly on a selective patient.
Accidents, Traffic ; Arthrodesis ; Birth Injuries ; Brachial Plexus ; Diagnosis ; Dislocations ; Extremities ; Female ; Humans ; Magnetic Resonance Imaging ; Male ; Methods ; Myelography ; Nerve Transfer ; Prognosis ; Seoul ; Surgical Procedures, Operative ; Wounds and Injuries

Liquid crystal thermography is a new diagnostic imaging method detecting the temperature change by the physiologic disturbance as compared with the radilogic method detecting the anatomical distortion. We have used liquid crystal thermography in 54 patients with complaining low back pain during the period form 2nd. March 1989 to 30th. April 1989. Of these 54 patients, 35 had myelography and C-T scan, 23 had EMG, and 13 were operated upon. 1. There were 35 clinically positive patients on whom concomitant myelography and C-T scan was performed; 32 patients(91%) had a positive myelography and C-T scan, and 30 patients (86%) had a positive thermography. Of these 35 patients, 23 had EMG concomitantly; 17 patients(74%) had a positive EMG and 18 patients(78%) had a positive thermography. 2. Liquid crystal thermography correlated with myelography and C-T scan in 31 patients(89%), EMG in 18 patients(78%). 3. Concomitant thermography, myelography and C-T scan, and surgery were performed on 13 patients among them EMG was added on 5 patients; Myelography and C-T scan had 100% accuracy, thermography had 92% accuracy, and EMG had 80 % accuracy. 4. Liquid crystal thermography is non-invasive method, dose not involve the use of ionizing radiation, and correlates well with clinical and surgical findings and other diagnostic methods, and costs relatively low. So, liquid crystal thermography is useful and reliable diagnostic method in patients with low back pain.
Diagnostic Imaging ; Humans ; Liquid Crystals ; Low Back Pain ; Methods ; Myelography ; Radiation, Ionizing ; Thermography

Even though the brachial plexus injury causes catastrophic loss of function of the corresponding upper extremity, it must be treated by conservative method for a long duration of time. But recently more challengeable surgical approaches such as neurorrhapy, nerve grafting, neurotization, muscle transfer and myocutaneous flap are being attempted. We have managed 26 cases of brachial plexus injury since 1979, and have obtained results as follows: 1. The most common cause was traffic accident(10 cases) including motor cycle accident. 2. The most frequent injury was due to traction mechanism(9 cases). 3. It required an average of 7.2 weeks for the diagnosis and therapeutic evaluation of brachial plexus injury. 4. Humerus fractures were the most common associated injury(7 cases). 5. Electromyography was conducted in most cases(20 cases), and cervical myelography was done in 5 cases. 6. The most common single injuries occured at the root level(7 cases) and next common site was trunk level(5 cases). But it happened most often in mixed type injury(12 cases). 7. Loss of motor power was most severe in finger flexors, and wrist flexors and extensors after brachial plexus injuries. But recovery was more rapid and complete in elbow flexors and deltoid. 8. If pain persisted for more than 6 months, the prognosis was relatively poor. 9. Surgical procedures were performed in 6 cases, one case of neurorrhapy, 2 cases of neurolysis, 2 cases of myocutaneous flap and one case of muscle transfer. 10. For the cases which did not improve with conservative mangement, operative procedures led to better results after determining appropriate indication.
Brachial Plexus ; Diagnosis ; Elbow ; Electromyography ; Fingers ; Humerus ; Methods ; Myelography ; Myocutaneous Flap ; Nerve Transfer ; Prognosis ; Surgical Procedures, Operative ; Traction ; Transplants ; Upper Extremity ; Wrist