title: Lower limb pain caused by insufficient muscular microcirculation.
abstract: Lumbar spinal surgery is a common procedure to treat low back pain. To remark that lower limb perfusion insufficiency may induce the similar syndrome as neuropathic pain, 1,076 cases of postspinal surgery was surveyed within 5 years, in which 51 cases had no obvious improvement 3 months after surgery; 27 cases received second operation because of instability, inadequate decompression, and wrong level; and the other 27 cases including 3 cases after twice spinal surgeries were enrolled. Physical examinations were presented with atypical neuropathic pain and muscle wasting at single lower limbs which deteriorated with long-distance walking. Computed tomography or magnetic resonance imaging scan was studied including the neural structure and lower limb angiography. The report showed degenerative change without definite neural structural compression or vascular occlusion. There was also no significant finding of electrodiagnostic study. The rest radionuclide study of lower limb muscle and myocardium was performed in these 27 cases using Thallium-201. All patients presented 9-24 % (~14%) muscle perfusion difference compared with two legs. Most of peripheral arterial occlusion disease cases presented the symptoms with ischemic pain and vascular claudication. In the study, the patients presented not only ischemic limb but also the bizarre symptoms, such as low back pain with or without radiating root pain and sensory disturbance. Physicians should be aware of the possibility of lower limb pain caused by lower perfusion syndrome.
authors.affiliation: Department of Neurosurgery, Chung Shan Medical University Hospital, Taichung, Taiwan ; Department of Nuclear Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan ; Department of Radiology, Chung Shan Medical University Hospital, Taichung, Taiwan ; School of Medicine, College of Medicine, Chung Shan Medical University, Taichung, Taiwan.
authors.forename: Jung-Tung
authors.initials: JT
authors.lastname: Liu
authors.affiliation: Department of Neurosurgery, Chung Shan Medical University Hospital, Taichung, Taiwan ; Department of Nuclear Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan ; Department of Radiology, Chung Shan Medical University Hospital, Taichung, Taiwan.
authors.forename: Wen-Jui
authors.initials: WJ
authors.lastname: Liao
authors.affiliation: Department of Neurosurgery, Chung Shan Medical University Hospital, Taichung, Taiwan ; Department of Nuclear Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan ; Department of Radiology, Chung Shan Medical University Hospital, Taichung, Taiwan.
authors.forename: Cheng-Siu
authors.initials: CS
authors.lastname: Chang
authors.affiliation: Graduate Institute of Integrated Medicine, China Medical University, No. 91, Hsueh-Shih Road, Taichung, 40402 Taiwan ; Department of Medical Research, China Medical University Hospital, Taichung, Taiwan.
authors.forename: Yung-Hsiang
authors.initials: YH
authors.lastname: Chen
keywords: Failed back surgery syndrome; Lower limb perfusion insufficiency; Microcirculation; Neurogenic claudication