I ndex
Note: Page numbers of article titles are in boldface type.
A
Analgesia/analgesics, nonopioid, for radiculopathy, 128
Ankle dorsiflexion test, in lumbar radiculopathy examination, 31–32
Anterior cervical diskectomy and fusion, for cervical radiculopathy, 181
Anterior cervical foraminotomy, for cervical radiculopathy, 182
Anti-inflammatory drugs, nonsteroidal, for radiculopathy, 129–133
Anti–tumor necrosis factor a, for radiculopathy, 132–133
Arm pain, spinal-related, defined, 105
B
Bone scintigraphy, in radiculopathy, 54–55
Bowstring sign, in lumbar radiculopathy examination, 30–31
Braggard sign, in lumbar radiculopathy examination, 31–32
C
Cauda equina syndrome, 172–173
signs and symptoms of, 172
surgical treatment of
options, 172
outcomes, 173
timing of, 173
Cervical disk arthroplasty, in cervical radiculopathy management, 182
Cervical radiculopathy
ESIs for, 149–159. See also Epidural steroid injections (ESIs), for cervical radiculopathy.
natural history of, 2–3
surgical treatment of, 179–191
anterior cervical diskectomy and fusion in, 181
anterior cervical foraminotomy in, 182
cervical disk arthroplasty in, 182
described, 179
indications for, 180
options, 180–182
outcomes, 183–188
posterior cervical foraminotomy in, 180–181
Cervical spine, physical examination of, 10–28
Hoffmann sign in, 28
Lhermitte sign in, 11
neck distraction test in, 27
Phys Med Rehabil Clin N Am 22 (2011) 193–199
doi:10.1016/S1047-9651(11)00009-X pmr.theclinics.com
1047-9651/11/$ – see front matter ª 2011 Elsevier Inc. All rights reserved.
194 Index
Cervical (continued )
provocative tests in, 10–28
shoulder abduction test in, 11, 27
Spurling test in, 10–11
upper limb tension test in, 27
Cervical spine–related extremity symptoms, 110
Computed tomography (CT), in radiculopathy, 3–4, 47–51
Conventional microdiskectomy, in lumbar radiculopathy management, 164–165
Core stabilization, in lumbosacral radiculopathy, 91–103. See also Lumbosacral
radiculopathy, core stabilization in.
Crossed femoral nerve test, in lumbar radiculopathy examination, 33
Crossed straight leg raise, in lumbar radiculopathy examination, 30
CT. See Computed tomography (CT).
D
Dermatome(s), 7–10, 12–13
defined, 7
Diskectomy
ILESI vs., efficacy of, 142–143
open, in lumbar radiculopathy management, 163–164
Drug(s), for radiculopathy, 127–137. See also Radiculopathy, pharmaceutical therapy for.
E
Electrodiagnosis
defined, 59
of radiculopathy, 59–74. See also Radiculopathy, electrodiagnostic evaluation of.
Electromyography (EMG), of radiculopathy, sensitivity of, 61–62
EMG. See Electromyography (EMG).
Epidural steroid injections (ESIs)
caudal
ILESI vs., 142
steroids in, efficacy of, 143–144
TFESI vs., 142
for cervical radiculopathy, 149–159
anatomy relevant to, 151
approaches to, 151–156
complications of, 150–151
described, 149
efficacy of, 151–156
evidence for, 151–156
fluoroscopy in, 152–153
indications for, 150
injectate in, 153
intraluminar approach to, 153–156
transforaminal approach to, 154–156
Evoked potentials, in electrodiagnostic evaluation of radiculopathy, 65–67
Exercise(s), in core stabilization for lumbosacral radiculopathy, 95–100
efficacy of, 98–100
registration of functional activity, 98
Index 195
F
F wave, as electrodiagnostic response in radiculopathy examination, 64
Femoral nerve stretch test, in lumbar radiculopathy examination, 32–33
Flip sign, in lumbar radiculopathy examination, 32
Fluoroscopy, with ESIs for cervical radiculopathy, 152–153
H
H reflex, as electrodiagnostic response in radiculopathy examination, 63–64
Hoffmann sign, in cervical spine examination, 28
Hoover sign, in lumbar radiculopathy examination, 34
I
ILESI. See Intralaminar epidural steroid injection (ILESI).
Imaging, in radiculopathy, 41–57. See also specific types and Radiculopathy, imaging in.
Intralaminar epidural steroid injection (ILESI)
diskectomy vs., efficacy of, 142–143
nonguided, steroids in, efficacy of, 143
TFESI vs., 142
efficacy of, 144–145
K
Kemp sign, in lumbar radiculopathy examination, 32
L
Leg pain, spinal-related, defined, 105
Lhermitte sign, in cervical spine examination, 11
Ligament(s), in spinal stability, 92
Local core musculature, in spinal stability, 92–93
Lumbar disk, herniated, natural history of, 162–163
Lumbar epidural steroid injections, efficacy of, 139–148
described, 139–140
level 1 evidence, 140–144
level 2 evidence, 144–145
level 3 evidence, 145–146
level 4 evidence, 146
Lumbar radiculopathy
pathophysiology of, 162
physical examination in, 28–34
ankle dorsiflexion test in, 31–32
bowstring sign in, 30–31
Braggard sign in, 31–32
crossed femoral nerve test in, 33
crossed straight leg raise in, 30
femoral nerve stretch test in, 32–33
flip sign in, 32
Hoover sign in, 34
Kemp sign in, 32
196 Index
Lumbar (continued )
negative extension sign in, 32
nonorganic signs in, 33–34
provocative tests in, 28–34
slump test in, 31
straight leg raise/Lasegue sign/Lazarevic sign in, 28–30
surgical treatment of, 161–177
comparison of techniques, 165–167
complications related to, 167–168
conventional microdiskectomy in, 164–165
described, 161–162
for cauda equina syndrome, 172–173
indications for, 167
microendoscopic diskectomy/tubular diskectomy in, 165
open diskectomy in, 163–164
options, 163–167
outcomes, 171–172
outcomes trials, 169–171
Lumbar spine–related extremity symptoms, 110, 113
Lumbosacral radiculopathy, core stabilization in, 91–103
exercises for, 95–100
overview of, 91–92
spinal stability, anatomic principles of, 92–95. See also Spinal stability, anatomic
principles of.
M
Magnetic resonance imaging (MRI), in radiculopathy, 44–46
Maine Lumbar Spine trial, in lumbar radiculopathy management, 169–170
Microdiskectomy, conventional, in lumbar radiculopathy management, 164–165
Microendoscopic diskectomy/tubular diskectomy, in lumbar radiculopathy
management, 165
Mobilization, for radiculopathy, 105–125
clinical relevance of, 117, 120
discussion, 113
limitations of, 117
methods, 106–107
results, 107–113
risks associated with, 113, 117
Motor nerve conduction studies, of radiculopathy, 63
MRI. See Magnetic resonance imaging (MRI).
Muscle relaxants, oral, for radiculopathy, 132
Myotome(s), 7–10, 12–13
defined, 8–9
N
Neck distraction test, in cervical spine examination, 27
Needle electrode examination, in electrodiagnostic evaluation of radiculopathy, 67–69
Negative extension sign, in lumbar radiculopathy examination, 32
Neuromodulatory medications, for radiculopathy, 130–132
Index 197
Nonopioid analgesia, for radiculopathy, 128
Nonorganic signs, in lumbar radiculopathy examination, 33–34
O
Open diskectomy, in lumbar radiculopathy management, 163–164
Opioid(s), for radiculopathy, 128–129
Oral muscle relaxants, for radiculopathy, 132
Oral steroids, for radiculopathy, 130
Osseous structures, in spinal stability, 92
P
Pain
arm, spinal-related, defined, 105
leg, spinal-related, defined, 105
Paraspinal muscles, abnormalities of, identification of, in electrodiagnostic
evaluation of radiculopathy, 70
Plain radiographs, in radiculopathy, 41–44
Posterior cervical foraminotomy, in cervical radiculopathy management, 180–181
R
Radiculopathy
cervical. See Cervical radiculopathy.
defined, 75
described, 75–76
electrodiagnostic evaluation of, 59–74
EMG in, sensitivity of, 61–62
evoked potentials in, 65–67
late responses, 63–64
F wave, 64
H reflex, 63–64
motor nerve conduction studies in, 63
needle electrode examination in, 67–69
nerve root variation in, 60–61
outcomes of, 70
paraspinal muscle abnormality identification in, 70
patient history in, 60
physical examination findings in, 60
segmental localization in, 69
sensory nerve conduction studies in, 62–63
epidemiology of, 1–2, 106
imaging in, 41–57
bone scintigraphy, 54–55
CT, 47–51
MRI, 44–46
plain radiographs, 41–44
selective nerve root block, 51–54
lumbar. See Lumbar radiculopathy.
lumbosacral
198 Index
Radiculopathy (continued)
core stabilization in, 91–103. See also Lumbosacral radiculopathy,
core stabilization in.
natural history of, 2
mechanical and inflammatory factors in, 85
medical diagnosis of, 75–89
clinical findings in, 78–81
research findings, 79–81
clinician and patient education in, 85–86
directional preference identification in, 81–84
flow chart in, 84–85
overview of, 76–78
mobilization for, 105–125. See also Mobilization, for radiculopathy.
natural history of, 1–5
pathophysiology of, 162
pharmaceutical therapy for, 127–137
anti–tumor necrosis factor a, 132–133
considerations related to, 133–134
described, 127–128
nonopioid analgesia, 128
NSAIDs, 129–133
opioids, 128–129
physical examination in, 7–40
cervical spine, 10–28. See also Cervical spine, physical examination of.
radiographic findings in, evolution of, 3–4
spinal manipulation for, 105–125. See also Spinal manipulation, for radiculopathy.
treatment of, 75–89
overview of, 76–78
Radiography
in radiculopathy, evolution of, 3–4
plain, in radiculopathy, 41–44
S
Scintigraphy, bone, in radiculopathy, 54–55
Segmental localization, in electrodiagnostic evaluation of radiculopathy, 69
Selective nerve root block, in radiculopathy, 51–54
Sensory nerve conduction studies, of radiculopathy, 62–63
Shoulder abduction test, in cervical spine examination, 11, 28
Slump test, in lumbar radiculopathy examination, 31
Spinal flexibility, 94–95
Spinal manipulation, for radiculopathy, 105–125
clinical relevance of, 117, 120
discussion, 113
limitations of, 117
methods, 106–107
results, 107–113
risks associated with, 113, 117
Spinal stability, anatomic principles of, 92–95
global muscles affecting core, 93–94
ligaments, 92
Index 199
local core musculature, 92–93
osseous structures, 92
spinal flexibility, 94–95
Spinal-related arm or leg pain, defined, 105
SPORT trial, in lumbar radiculopathy management, 170–171
Spurling test, in cervical spine examination, 10–11
Stabilization, core, in lumbosacral radiculopathy, 91–103. See also Lumbosacral
radiculopathy, core stabilization in.
Steroid(s)
in caudal ESIs, efficacy of, 143–144
in nonguided ILESI, efficacy of, 143
oral, for radiculopathy, 130
Straight leg raise/Lasegue sign/Lazarevic sign, in lumbar radiculopathy
examination, 28–30
T
TFESI. See Transforaminal epidural steroid injection (TFESI).
Topical treatments, for radiculopathy, 133
Transforaminal epidural steroid injection (TFESI)
efficacy of, 144
ILESI vs., efficacy of, 142, 144–145
steroids in, efficacy of, 140–142
U
Upper limb tension test, in cervical spine examination, 27
W
Weber trial, in lumbar radiculopathy management, 169
