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Journal of Bone and Joint Surgery - British Volume, Vol 86-B, Issue 1, 74-80.
doi: 10.1302/0301-620X.86B1.14344  
Copyright © 2004 by British Editorial Society of Bone and Joint Surgery
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Correlation of nerve root pain with dermatomal sensory threshold and back pain with spinal movement in single level lumbar spondylosis

N.A Quraishi, MRCS, Specialist Registrar in Orthopaedic Surgery1; O. Taherzadeh, FRCS, Clinical Research Fellow1; A. H. McGregor, PhD, Senior Lecturer in Biodynamics2; S. P. F. Hughes, FRCS, Professor of Orthopaedic Surgery2; and P. Anand, FRCP, Professor of Clinical Neurology1

1 Peripheral Neuropathy Unit, Imperial College London, Hammersmith Hospital, Du Cane Road, London W12 0NN, UK.
2 Department of Musculoskeletal Surgery, Imperial College London, Charing Cross Hospital, Fulham Palace Road, London W6 8RF, UK.

Correspondence should be sent to Professor P. Anand.

We studied 27 patients with low back pain and unilateral L5 or S1 spinal nerve root pain. Significant radiological changes were restricted to the symptomatic root level, when compared with controls. Low back and leg pain were graded on a visual analogue scale. Dermatomal quantitative sensory tests revealed significant elevations of warm, cool and touch perception thresholds in the affected dermatome, compared with controls. These elevations correlated with root pain (warm v L5 root pain; r = 0.88, p < 0.0001), but not with back pain. Low back pain correlated with restriction of anteroposterior spinal flexion (p = 0.02), but not with leg pain.

A subset of 16 patients underwent decompressive surgery with improvement of pain scores, sensory thresholds and spinal mobility. A further 14 patients with back pain, multilevel nerve root symptoms and radiological changes were also studied. The only correlation found was of low back pain with spinal movement (p < 0.002). We conclude that, in patients with single level disease, dermatomal sensory threshold elevation and restriction of spinal movement are independent correlates of sciatica and low back pain.






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Hip, Knee, Trauma, Upper limb, Foot & Ankle, Paediatrics, Oncology, Spine, Arthroplasty, General