TAILIEUCHUNG - Spinal Disorders: Fundamentals of Diagnosis and Treatment Part 32

Spinal Disorders: Fundamentals of Diagnosis and Treatment Part 32. Spinal disorders are among the most common medical conditions with significant impact on health related quality of life, use of health care resources and socio-economic costs. Spinal surgery is still one of the fastest growing areas in clinical medicine. | 292 Section Patient Assessment Case Introduction A63-year-old male patient underwent a left-sided discectomy of L5 S1 for an S1 radiculopathy. After a pain free interval of 5 months he presented again with severe recurrent left sided leg pain predominantly at the posterolateral aspect of the calf. An MRI scan showed a small recurrent sequestrated disc herniation at the level previously operated on a b .The patient was referred to a neurologist because the clinical findings and the imaging study did not completely match. A detailed history revealed that the patient reported pain in the lower back down to the left calf and heel. However he additionally felt numbness in the thoracoabdominal skin on the left side. The neurological examination revealed an absent left Achilles tendon reflex hypesthesia of the left T6-T10 and S1 dermatomes but no paresis. The L5 dermatome presented petechial efflorescence c d .The EMG of the gastrognemius muscle confirmed chronic denervation as a sign of a radicular lesion probably caused by the disc herniation of the S1 root. However prolonged tibial somatosensory evoked potential hypesthesia of the thoracic dermatomes as well as the dermatomal efflorescence suggested an additional neurological disorder. The suspected diagnosis of a herpes associated myelitis was confirmed by pathological antibodytiters against herpes zoster virus and increased cell count 65 pl and protein level g l in the patient was treated with acyclovir . application over 5 days and continued oral medication for 3 months . Three months later the pain had completely subsided and the patient regained full neurological function. Neurological Assessment in Spinal Disorders Chapter 11 293 Peripheral neurological disorders may mimic radiculopathy and should be differentiated by the neurological examination and complementary neurophysiological tests. For example polyneuropathy can cause similar symptoms to lumbar stenosis. While the clinical examination .

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