Kim Shin Jae, Ko Myeong Jin, Lee Young Seok, Park Seung Won, Kim Young Baeg, Chung Chan
Department of Neurosurgery, College of Medicine, Chung-Ang University, Seoul, Korea.
Department of Neurosurgery, College of Medicine, Dongguk University, Gyungju, Korea.
Korean J Spine. 2014 Jun;11(2):57-61. doi: 10.14245/kjs.2014.11.2.57. Epub 2014 Jun 30.
Patients with cervical (CDRS) or lumbar dorsal ramus syndrome (LDRS) are characterized by neck or low back pain with referred pain to upper or lower extremities. However, we experienced some CDRS or LDRS patients with unusual motor or bladder symptoms. We analyzed and reviewed literatures on the unusual symptoms identified in patients with CDRS or LDRS.
This study included patients with unusual symptoms and no disorders of spine and central nervous system, a total of 206 CDRS/LDRS patients over the past 3 years. We diagnosed by using double diagnostic blocks for medial branches of dorsal rami of cervical or lumbar spine with 1% lidocaine or 0.5% bupivacaine for each block with an interval of more than 1 week between the blocks. Greater than 80% reduction of the symptoms, including unusual symptoms, was considered as a positive response. The patients with a positive response were treated with radiofrequencyneurotomy.
The number of patients diagnosed with CDRS and LDRS was 86 and 120, respectively. Nine patients (10.5%) in the CDRS group had unusual symptoms, including 4 patients with motor weakness of the arm, 3 patients with tremors, and rotatory torticollis in 2 patients. Ten patients (8.3%) in the LDRS group showed unusual symptoms, including 7 patients with motor weakness of leg, 2 patients with leg tremor, and urinary incontinence in 1 patient. All the unusual symptoms combined with CDRS or LDRS were resolved after treatment.
It seems that the clinical presentationssuch as motor weakness, tremor, urinary incontinence without any other etiologic origin need to be checked for unusual symptoms of CDRS or LDRS.
颈背支综合征（CDRS）或腰背支综合征（LDRS）患者的特征是颈部或下背部疼痛，并伴有上肢或下肢的牵涉痛。然而，我们遇到了一些有不寻常运动或膀胱症状的CDRS或LDRS患者。我们分析并回顾了有关CDRS或LDRS患者中发现的不寻常症状的文献。
本研究纳入了有不寻常症状且无脊柱和中枢神经系统疾病的患者，在过去3年中共有206例CDRS/LDRS患者。我们通过对颈椎或腰椎背支内侧支进行双重诊断性阻滞来进行诊断，每次阻滞使用1%利多卡因或0.5%布比卡因，两次阻滞间隔超过1周。症状（包括不寻常症状）减轻超过80%被视为阳性反应。对有阳性反应的患者进行射频神经切断术治疗。
诊断为CDRS和LDRS的患者数量分别为86例和120例。CDRS组中有9例患者（10.5%）有不寻常症状，包括4例手臂运动无力、3例震颤和2例旋转性斜颈。LDRS组中有10例患者（8.3%）表现出不寻常症状，包括7例腿部运动无力、2例腿部震颤和1例尿失禁。所有与CDRS或LDRS相关的不寻常症状在治疗后均得到缓解。
对于没有任何其他病因的运动无力、震颤、尿失禁等临床表现，似乎需要检查是否存在CDRS或LDRS的不寻常症状。
