요천추 추간판 탈출환자에서 하지직거상 검사의 임상적 가치
Clinical Value of Straight Leg Raising Test in Patients with Lumbosacral Herniated Intervertebral Disc
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Objectives: SLRT (Straight Leg Raising Test) is a useful test to lumbar HNP (Herniated Nucleus Pulposus). We tried to know 1) the correlation between SLRT and anatomical lesion, and 2) the correlation between SLRT and electrodiagnostic study. Methods: Among the patients who have lumbar pain, those who have 1) lower extremity radiating pain, 2) SLRT positive sign, and 3) abnormal MRI finding were selected as the object of this study. By the degree of HNP, it was classified as 1) bulging, protrusion, and 2) extrusion, sequestration group. By the direction of HNP, it was classified as 1)central, lateral, and 2) laterocentral, centrolateral group. By the site of HNP, it was classified as 1) L2-3, L3-4, and 2) L4-5, L5-S1. We checked nerve conduction study and needle electromyography on back and lower extremity. The results of radiologic measurements and electrodiagnostic studies were compared with SLRT. Results: The presence of 1) L4-5, L5-S1 HNP, 2) posterolateral HNP, 3) Abnormal spontaneous activities in needle EMG and 4) delayed latency of gastrocnemius H-Reflex were associated with decreasing SLRT (p<0.05). Conclusion: This study suggested that SLRT seems to be a useful adjunctive method to diagnosis of lumbosacral HNP and radiculopathy.
Abstract
Objectives: SLRT (Straight Leg Raising Test) is a useful test to lumbar HNP (Herniated Nucleus Pulposus). We tried to know 1) the correlation between SLRT and anatomical lesion, and 2) the correlation between SLRT and electrodiagnostic study. Methods: Among the patients who have lumbar pain, those who have 1) lower extremity radiating pain, 2) SLRT positive sign, and 3) abnormal MRI finding were selected as the object of this study. By the degree of HNP, it was classified as 1) bulging, protrusion, and 2) extrusion, sequestration group. By the direction of HNP, it was classified as 1)central, lateral, and 2) laterocentral, centrolateral group. By the site of HNP, it was classified as 1) L2-3, L3-4, and 2) L4-5, L5-S1. We checked nerve conduction study and needle electromyography on back and lower extremity. The results of radiologic measurements and electrodiagnostic studies were compared with SLRT. Results: The presence of 1) L4-5, L5-S1 HNP, 2) posterolateral HNP, 3) Abnormal spontaneous activities in needle EMG and 4) delayed latency of gastrocnemius H-Reflex were associated with decreasing SLRT (p<0.05). Conclusion: This study suggested that SLRT seems to be a useful adjunctive method to diagnosis of lumbosacral HNP and radiculopathy.
참고문헌 (21)
- Woodhall, Barnes, "The well-leg-raising test of Fajersztajin in the diagnosis of ruptured lumbar intervertebral disc", J Bone Joint Surg Am, 32, pp.786~792 (1950)
- Fisher MA, "Clinical and electrophysiological appraisal of the significance of radicular injury in back pain", J Neurol Neurosurg Psychiatry, 41, pp.303~306 (1978)
- Read RL, "Stress testing in nerve compression", Hand Clin, 7, pp.521~526 (1991)
- O’Connell JEA, "Sciatica and the mechanism of the production of the clinical syndrome in protrusions of the lumbar intervertebral disca", Br J Surg, 30, pp.315~327 (1943)
- Xin SQ, "Significance of the straightleg raising test in the diagnosis and clinical evaluation of lower lumbar intervertebral-disc protrusion", J Bone Joint Surg Am, 69, pp.517~522 (1987)
- Brody IA, "The signs of Kernig and Brudzinski", Arch Neurol, 21, pp.215~218 (1969)
- Edgar MA, "Induced pain patterns on passive straight-leg raising in lower lumbar disc protrusion: A' prospective clinical, myelographic and operative study in fifty patients", J Bone Joint Surg Br, 56, pp.658~667 (1974)
- Lindahl O, "Histologic changes in spinal nerve roots of operated cases of sciatica", Acta Orthop Scand, 20, pp.215~225 (1951)
- Nachemson A, "Intradiscal measursements of pH in patients with lumbar rhizopathies", Acta Orhtop Scand, 40, pp.23~42 (1969)
- Kimura J, "Electrodiagnosis in disease of nerve and muscle: principles and practice, 3rd ed", pp.339~362 (2001), Oxford University Press
- Kosteljantez M, "The clinical significance of straight-leg raising (Laseque’s sign) in the diagnosis of prolapsed lumbar disc: interobserver variation and correlation with surgical finding", Spine, 13, pp.393~395 (1988)
- Thelander U, "Straight leg raising test versus radiologic size, shape, and position of lumbar disc hernias", Spine, 17, pp.395~399 (1992)
- Summers B, "Low back pain on passive straight leg raising: the anterior theca as a source of pain", Spine, 30(3), pp.342~345 (2005)
- Kobayashi S, "Pathology of lumbar nerve root compression Part 1: intraradicular inflammatory changes induced by mechanical compression", J Orthop Res, 22, pp.170~179 (2004)
- Garfin SR, "Compressive neuropathy of spinal nerve roots", Spine, 16, pp.162~166 (1991)
- Kobayashi S, "Effect of mechanical compressin on the lumbar nerve root: localization and changes of intraradicular inflammatory cytokines, nitric oxide, and cyclooxygenase", Spine, 30, pp.1699~1705 (2005)
- 이일훈, "요통환자의 하지직거상 검사와 근전도 및 방사선학적 소견의 비교", 대한재활의학회지, 20, pp.333~338 (1996)
- Goddard MD, "Movements induced by straight leg raising in the lumbo-sacral roots, nerve and plexus, and in the intrapelvic section of the sciatic nerve", J Neurol Neurosurg Psychiatry, 28, pp.12~18 (1965)
- Nishida T, "H reflex in S-1 radiculopathy: latency versus amplitude controversy revisited", Muscle Nerve, 19, pp.915~917 (1996)
- 김철완, "요수 신경근 병변 진단에 있어 H 반사의 유용성에 대한 고찰", 대한재활의학회지, 19, pp.90~96 (1995)
- 김윤기, "단일 편측 제5 요수 신경근 병변에서 전경골근 H반사의 진단적 가치", Annals of Rehabilitation Medicine, 27(5), pp.12~716 (2003), 대한재활의학회