title: Unusual clinical presentations of cervical or lumbar dorsal ramus syndrome.
abstract: OBJECTIVE
  Patients with cervical (CDRS) or lumbar dorsal ramus syndrome (LDRS) are characterized by neck or low back pain with referred pain to upper or lower extremities. However, we experienced some CDRS or LDRS patients with unusual motor or bladder symptoms. We analyzed and reviewed literatures on the unusual symptoms identified in patients with CDRS or LDRS.
  
  
  METHODS
  This study included patients with unusual symptoms and no disorders of spine and central nervous system, a total of 206 CDRS/LDRS patients over the past 3 years. We diagnosed by using double diagnostic blocks for medial branches of dorsal rami of cervical or lumbar spine with 1% lidocaine or 0.5% bupivacaine for each block with an interval of more than 1 week between the blocks. Greater than 80% reduction of the symptoms, including unusual symptoms, was considered as a positive response. The patients with a positive response were treated with radiofrequencyneurotomy.
  
  
  RESULTS
  The number of patients diagnosed with CDRS and LDRS was 86 and 120, respectively. Nine patients (10.5%) in the CDRS group had unusual symptoms, including 4 patients with motor weakness of the arm, 3 patients with tremors, and rotatory torticollis in 2 patients. Ten patients (8.3%) in the LDRS group showed unusual symptoms, including 7 patients with motor weakness of leg, 2 patients with leg tremor, and urinary incontinence in 1 patient. All the unusual symptoms combined with CDRS or LDRS were resolved after treatment.
  
  
  CONCLUSIONS
  It seems that the clinical presentationssuch as motor weakness, tremor, urinary incontinence without any other etiologic origin need to be checked for unusual symptoms of CDRS or LDRS.
authors.affiliation: Department of Neurosurgery, College of Medicine, Chung-Ang University, Seoul, Korea.
authors.forename: Shin Jae
authors.initials: SJ
authors.lastname: Kim
authors.affiliation: Department of Neurosurgery, College of Medicine, Chung-Ang University, Seoul, Korea.
authors.forename: Myeong Jin
authors.initials: MJ
authors.lastname: Ko
authors.affiliation: Department of Neurosurgery, College of Medicine, Chung-Ang University, Seoul, Korea.
authors.forename: Young Seok
authors.initials: YS
authors.lastname: Lee
authors.affiliation: Department of Neurosurgery, College of Medicine, Chung-Ang University, Seoul, Korea.
authors.forename: Seung Won
authors.initials: SW
authors.lastname: Park
authors.affiliation: Department of Neurosurgery, College of Medicine, Chung-Ang University, Seoul, Korea.
authors.forename: Young Baeg
authors.initials: YB
authors.lastname: Kim
authors.affiliation: Department of Neurosurgery, College of Medicine, Dongguk University, Gyungju, Korea.
authors.forename: Chan
authors.initials: C
authors.lastname: Chung
keywords: Low back pain; Neck pain; Paralysis; Spinal nerves; Tremor; Urinary incontinence
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