A quantitative analysis of sensory function in lumbar radiculopathy using current perception threshold testing.
METHODS
Peripheral sensory functions in patients with radiculopathy resulting from lumbar disc herniation and in control individuals were analyzed using current perception threshold testing.


OBJECTIVE
To evaluate the severity of sensory disturbance quantitatively in patients with lumbar radiculopathy.


BACKGROUND
Subjective evaluation of the severity of sensory disturbance associated with spinal disorders using conventional methods often is difficult. Current perception threshold evaluation is a recently proposed method for studying peripheral nerve dysfunction. This is a quantitative sensory test for analyzing functions of A-beta, A-delta, and C fibers.


METHODS
In this study, 48 patients with lumbar radiculopathy resulting from lumbar disc herniation were examined. The mean age of the patients was 37.9 years. All the patients had pain distribution from the compression of one lumbar nerve root (L5 or S1), and unequivocal unilateral disc herniation of the corresponding level was shown by magnetic resonance imaging. Eleven healthy volunteers were used as control subjects. Their mean age was 38.2 years. Current perception threshold evaluation using a Neurometer device was performed at three frequencies: 2000, 250, and 5 Hz. The stimulus sites were located on the dorsal side of the first metatarsus (the L5 dermatome) and the dorsal side of the fifth metatarsus (the S1 dermatome). These sites were investigated on both legs in all the patients and control subjects. The intensity of pain was scored using a visual analog scale.


RESULTS
In the control group, there were no significant differences in current perception threshold values at any frequency between the left and right legs. In the patient group, the current perception threshold values in the affected legs were significantly higher than those in the contralateral legs at all frequencies. The current perception threshold values in the affected legs in the patient group were significantly higher than those in the control subjects at 2000 and 250 Hz, whereas there were no significant differences at 5 Hz. The current perception threshold values in the affected legs were significantly higher in patients with hypesthesia than in those without hypesthesia at 2000 and 250 Hz, and in patients with severe pain than in those with less pain at 5 Hz.


CONCLUSIONS
Current perception threshold testing showed that the functions of A-beta, A-delta, and C fibers deteriorated in patients with lumbar radiculopathy. This technique may be useful for quantifying sensory nerve dysfunction in patients with radiculopathy.
Department of Orthopaedic Surgery, Sapporo Medical University, Sapporo, Japan. tyamasit@sapmed.ac.jp
Toshihiko
T
Yamashita
Kunihito
K
Kanaya
Masatoshi
M
Sekine
Tsuneo
T
Takebayashi
Satoshi
S
Kawaguchi
Genichirou
G
Katahira
D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D006987:Hypesthesia / Q000503:physiopathology; D007405:Intervertebral Disc Displacement / Q000150:complications*; D008159:Lumbar Vertebrae / Q000294:innervation* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009460:Neurologic Examination / Q000379:methods*; D010146:Pain / Q000503:physiopathology; D010465:Perception; D011843:Radiculopathy / Q000209:etiology / Q000503:physiopathology*; D012684:Sensory Thresholds / Q000502:physiology*