Abstract
The diagnostic sensitivity of dermatomal somatosensory evoked potentials (DSEPs) was evaluated in a homogeneous group of fifteen patients with low back pain due to isolated lumbosacral radiculopathy. The normative values from L3 to S1 were defined, as were the parameters of abnormality. In seven patients with pseudoradicular or referred leg pain, a negative neurological examination and images indicative of protrusion or paramedian disc hernia, the DSEPs were normal in six cases and slightly altered in one. In eight patients with deafferentiation leg pain, clinical signs of root damage and images indicative of an intraforaminal hernia, the DSEPs showed varying degrees of alteration which could generally be correlated to the severity of the clinical picture.
This method can therefore be useful in differentiating pain due to stimulation of the receptors of the osteoarticular structures or the root sheath, in which the DSEPs are normal, from pain due to direct root damage, in which the DSEPs are altered. This functional evaluation of anatomical damage provides further information which may help to achieve a better therapeutic approach.
Sommario
La sensibilità diagnostica dei Potenziali Evocati Sensitivi Dermatomerici (DSEP) è stata valutata in una casistica omogenea di 15 pazienti con lombosciatalgia da monoradicolopatia lombo-sacrale. Sono stati definiti i valori normativi da L3 a S1 e i parametri di anormalità. In 7 pazienti con pseudoradicular or referred leg pain, obiettività neurologica negativa e imaging indicativa di protrusione o ernia discale paramediana, i DSEP sono risultati normaliin 6 casi e modestamente alterati in 1 caso. In 8 pazienti con de-afferentation leg pain, segni clinici di danno radicolare e imaging indicativa di ernia intraforaminale i DSEP presentavano vari gradi di alterazione, in genere correlabili alla severità del quadro clinico.
Il metodopuò pertanto essere utile nel differenziare il dolore dovuto alla stimolazione dei recettori delle strutture osteo-articolari o delle guaine radicolari in cui i DSEP risultano normali, dal dolore dovuto a danno radicolare diretto in cui i DSEP risultano alterati. Questa valutazione del danno anatomico fornisce ulteriori informazioni che possono meglio indirizzare il comportamento terapeutico.
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Righetti, C.A., Tosi, L. & Zanette, G. Dermatomal somatosensory evoked potentials in the diagnosis of lumbosacral radiculopathies. Ital J Neuro Sci 17, 193–199 (1996). https://doi.org/10.1007/BF01995683
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DOI: https://doi.org/10.1007/BF01995683