Hallazgos morfológicos en pacientes con lumbalgia y ciática

  1. Pablo González Uriel 1
  2. Alberto Fernández Lastra 1
  3. José María Santín Amo 1
  4. Víctor Armesto Pérez 1
  5. Juan Antonio Suárez Quintanilla 2
  6. Anna Carrera 3
  7. Miguel Ángel Reina 4
  1. 1 Hospital Universitario Lucus Augusti
    info

    Hospital Universitario Lucus Augusti

    Lugo, España

    ROR https://ror.org/0416des07

  2. 2 Universidade de Santiago de Compostela
    info

    Universidade de Santiago de Compostela

    Santiago de Compostela, España

    ROR https://ror.org/030eybx10

  3. 3 Universitat de Girona
    info

    Universitat de Girona

    Girona, España

    ROR https://ror.org/01xdxns91

  4. 4 Hospital Universitario Montepríncipe (Boadilla del Monte)
Mostrar afiliacións +
Revista:
MPJ Multidisciplinary Pain Journal

ISSN: 2697-2263

Ano de publicación: 2021

Número: 1

Tipo: Artigo

DIALNET GOOGLE SCHOLAR lock_openAcceso aberto editor

Outras publicacións en: MPJ Multidisciplinary Pain Journal

Resumo

Introduction: Lumbociatic pain is a major cause of disability and absenteeism from work. Its pathophysiological substrate, mainly, is radiculopathy due to lumbar spondylosis or herniated discs. The objective of this study is to describe the alterations in the complementary tests (MRI and EMG), in patients with lumbociatalgia, with clinical suspicion of lumbosacral radiculopathy, in the context of herniated disc or spondylosis. Materials and methods: Retrospective study of 217 patients in which age and sex were analyzed; by MRI protrusions and herniated discs, discoosteophyte complexes, arthropathy, spondylolisthesis, canal stenosis, hypertrophy of the yellow ligament, sagittal vertebral alignment; neurogenic findings in muscles dependent on the spinal nerves from L3 to S1 have been analyzed by electrodiagnosis. Results: The mean age was 57.54 ± 12.31 years. The mean number of protrusions and herniated discs per spine was 1.26 ± 1.99. The number of patients with elements of spondylosis was: osteophytes n = 75, listhesis n = 40, canal stenosis n = 35, arthropathy n = 133, hypertrophy of the yellow ligament n = 72. Higher incidence of protrusions and herniated discs in L4-L5 (n = 144), of discoosteophytic complexes in L5-S1 (n = 42) and of neurogenic findings in the L5 spinal nerve (n = 169). The most characteristic vertebral alignment was preserved lordosis (n = 151). The elements of spondylosis increased with age significantly. Motor radiculopathies and discopathies increased with age in a non-significant way. Arthropathy, osteophytes, and L4 and L5 motor radiculopathies were more frequent in men. Conclusion: The poor anatomical correlation between the neurogenic findings in the muscles of a specific spinal nerve and the space-occupying lesions at the level of the homonymous intervertebral foramen, suggests that the rootlets of the cauda equina are damaged within the vertebral canal, due to occupying lesions of the cauda equina space, cranial to the expected intervertebral foramen.

Referencias bibliográficas

  • Deyo RA, Weinstein JN. Low back pain. N Engl J Med. 2001;344(5):363-60. DOI: 10.1056/NEJM200102013440508.
  • González Hidalgo M. Indicaciones de los estudios neurofisiológicos en el dolor lumbar. Rev Neurol. 2006;43(10):618-20. DOI: 10.33588/rn.4310.2005717.
  • Tarulli AW, Raynor EM. Lumbosacral radiculopathy. Neurol Clin. 2007;25(2):387-405. DOI: 10.1016/j.ncl.2007.01.008.
  • Moore KL. Anatomía con orientación clínica. 6.ed. Philadelphia: Wolters Kluwer; 2011.
  • Lestini WF, Wiesel SW. The pathogenesis of cervical spondylosis. Clin Orthop Relat Res. 1989;(239):69-93. DOI: 10.1097/00003086-198902000-00009.
  • Crock HV. Normal and pathological anatomy of the lumbar spinal nerve root canals. J Bone Joint Surg Br. 1981;63B(4):487-90. DOI: 10.1302/0301-620X.63B4.7298672.
  • Hsu PS, Armon C, Levin K. Acute Lumbosacral Radiculopathy: Pathophysiology, Clinical Features, and Diagnosis. Waltham, MA: UpToDate Inc.; 2020.
  • Khomand P, Ahsan B, Fazel S, Ghafari A. Comparison of diagnostic indices of MRI and EMG in diagnosis of lumbar radiculopathy. Chron Dis J. 2014;2(1):10-4.
  • Albeck MJ, Taher G, Lauritzen M, Trojaborg W. Diagnostic value of electrophysiological tests in patients with sciatica. Acta Neurol Scand 2000;101(4):249-54. DOI: 10.1034/j.1600-0404.2000.101004249.x.
  • Levin KH. Electrodiagnostic approach to the patient with suspected radiculopathy. Neurol Clin. 2002;20(2):397. DOI: 10.1016/S0733-8619(01)00006-8.
  • Barr K. Electrodiagnosis of Lumbar Radiculopathy. Phys Med Rehabil Clin N Am. 2013;24(1):79-91. DOI: 10.1016/j.pmr.2012.08.011.
  • Fardon DF, Milette PC. Nomenclature and classification of lumbar disc pathology. Recommendations of the Combined task Forces of the North American Spine Society, American Society of Spine Radiology, and American Society of Neuroradiology. Spine. 2001;26(5):E93-E113. DOI: 10.1097/00007632-200103010-00006.
  • Fardon DF, Williams AL, Dohring EJ, Reed Murtagh F, Rothman SLG, Sze GK, et al. Lumbar disc nomenclature: version 2.0. Spine J. 2014;14(11):2525-45. DOI: 10.1016/j.spinee.2014.04.022.
  • Cho SC, Ferrante MA, Levin KH, Harmon RL, So YT. Utility of Electrodiagnostic testing in evaluating patients with lumbosacral radiculopathy: An evidence-based review. Muscle Nerve. 2010;42(2):276-82. DOI: 10.1002/mus.21759.
  • Rubin DI. Needle electromyography: basic concepts and patterns of abnormalities. Neurol Clin. 2012;30(2):429-56. DOI: 10.1016/j.ncl.2011.12.009.
  • Heliovaara M. Epidemiology of sciatica and herniated lumbar intervertebral disc. The Social Insurance Institution, Finland, ML: 76, Helsinki; 1988.
  • Pouriesa M, Fouladi RF, Mesbahi S. Disproportion of end plates and the lumbar intervertebral disc herniation. Spine J. 2013;13(4):402-7. DOI: 10.1016/j.spinee.2012.11.047.
  • Jensen MC, Brant-Zawadzki MN, Obuchowski N, Modic MT, Malkasian D, Ross JS. Magnetic Resonance Imaging of the Lumbar Spine in People without Back Pain. N Engl J Med. 1994;331(2):69-73. DOI: 10.1056/NEJM199407143310201.
  • Middleton K, Fish DE. Lumbar spondylosis: clinical presentation and treatment approaches. Curr Rev Musculoskelet Med. 2009;2(2):94-104. DOI: 10.1007/s12178-009-9051-x.
  • Symmons DPM, van Hemert AM, Vandenbrouke JP, Valkenburg HA. A longitudinal study of back pain and radiological changes in the lumbar spines of middle aged women: radiographic findings. Ann Rheum Dis. 1991;50(3):162-6. DOI: 10.1136/ard.50.3.162.
  • Zukowski LA, Falsetti AB, Tillman MD. The influence of sex, age and BMI on the degeneration of the lumbar spine. J. Anat. 2012;220(1):57-66. DOI: 10.1111/j.1469-7580.2011.01444.x.
  • González Uriel P, Armesto Pérez V, Suárez-Quintanilla JA. Clinical anatomy of cervical spondylosis. Eur J Anat. 2020;24(5):439-48.
  • Peterson CK, Boulton JE, Wood AR. A cross-sectional study correlating lumbar spine degeneration with disability and pain. Spine. 2000;25(2):218-23. DOI: 10.1097/00007632-200001150-00013.
  • Kirkaldy Willis WH, Wedge JH, Joung Hing K, Reilly J. Pathology and pathogenesis of lumbar spondylosis and stenosis. Spine .1978;3(4):319-28. DOI: 10.1097/00007632-197812000-00004.
  • Vernon-Roberts B, Pirie CJ. Degenerative changes in the intervertebral discs of the lumbar spine and their sequelae. Rheumatol Rehabil. 1977;16(1):13-21. DOI: 10.1093/rheumatology/16.1.13.
  • Videman T, Battié MC, Gill K, Malmivaara A, Gibbons LE, Fisher LD. Magnetic resonance imaging findings and their relationship in the thoracic and lumbar spine: insights into the etiopathogenesis of spinal degeneration. Spine. 1995;20(8):928-35. DOI: 10.1097/00007632-199504150-00009.
  • Kalichman L, Suri P, Guermazi A, Li L, Hunter DJ. Facet orientation and tropism: associations with facet joint osteoarthritis and degenerative spondylolisthesis. Spine. 2009;34(16):E579-E585. DOI: 10.1097/BRS.0b013e3181aa2acb.
  • Safak AA, Is M, Sevinc O, Barut C, Eryoruk N, Erdogmus B, et al. The thickness of the ligamentum flavum in relation to age and gender. Clin Anat. 2010;23(1):79-83.
  • Watters WC, Bono CM, Gilbert TJ, Kreiner DS, Mazanec DJ, Shaffer WO, et al. An evidence-based clinical guideline for the diagnosis and treatment of degenerative lumbar spondylolisthesis. Spine J. 2009;9(7):609-14. DOI: 10.1016/j.spinee.2009.03.016.
  • Nardin RA, Patel MR, Gudas TH, Rutkove SB, Raynor EM. Electromyography and magnetic resonance imaging in the evaluation of radiculopathy. Muscle Nerve. 1999;22(2):151-5. DOI: 10.1002/(SICI)1097-4598(199902)22:2<151::AID-MUS2>3.0.CO;2-B.
  • Arslan Y, Yasar E, Zorlu Y. Correlation of electromyography and magnetic resonance imaging findings in the diagnosis of suspected radiculopathy. Turk J Neurol. 2016;22(2):55-9. DOI: 10.4274/tnd.99896.
  • Soltani ZR, Sajadi S, Tavana B. A comparison of magnetic resonance imaging with electrodiagnostic findings in the evaluation of clinical radiculopathy: A cross-sectional study. Eur Spine J. 2014;23(4):916-21. DOI: 10.1007/s00586-013-3164-z.
  • Brinjikji W, Luetmer PH, Comstock B, Bresnahan BW, Chen LE, Deyo RA, et al. Systematic Literature Review of Imaging Features of Spinal Degeneration in Asymptomatic Populations. AJNR Am J Neuroradiol. 2015;36(4):811-6. DOI: 10.3174/ajnr.A4173.
Fonte de datos: Dialnet