부산대학교 도서관

ObjectiveL5 nerve root innervation to hip abductors is well described but hip abductor weakness caused by acute L5 nerve root radiculopathy related to spine surgery is rarely depicted in the literature.Summary of Background DataIn acute L5 nerve root radiculopathy, weakness of hip abductors can result in limping gait in substantial portion of the patients. This type of limping is different from gait problem due to foot drop. The author investigated clinical outcome and electromyography (EMG) changes of gluteus medius (Gmed), tensor fascia lata (TFL), tibialis anterior (TA) muscles in surgically treated 21 cases between 2005 and 2012 with acute L5 radiculopathy.MethodsThis study included 21 patients with acute L5 nerve root radiculopathy who were referred to our institute for surgical treatment between 2005 and 2012. Lumbar disc herniation and L5 nerve root impingement were assessed by magnetic resonance imaging (MRI). 15 patients had a L4-5 disc herniation, 3 patients with L4-5 stenosis and disc herniation, 2 patients with L5-S1 upwardly migrated disc herniation, and the other had L5-S1 extraforaminal disc. Clinical outcome included visual analogue pain scores (VAS), physical examination. EMG testing was performed by two board-certified physiatrists, and one board-certified neurologist.ResultsEMG exhibited abnormal findings in Gmed, TFL, and TA muscles in every case and intraoperative monitoring was uneventful. All patients could walk independently but 9 patients showed mild to moderate limping gait postoperatively. Trendelenburg sign was positive in these 9 cases and definite weakness of hip abductors was observed. Ankle dorsiflexion was not aggravated postoperatively, so the weakness of the Gmed and TFL was considered to be the reason of walking problem. The limping gait was improved by 2 months postoperatively.ConclusionThe surgeon should be aware of the possibility of weakness in hip abductors and transient limping gait in acute L5 nerve root radiculopathy and should inform the patient.
급성기의 요추간판 탈출증 환자는 심한 요통 및 하지 방사통으로 인한 보행장애를 호소하는 경우가 종종 있다. 본 연구에서는 급성 제5요추 신경근병증으로 수술받은 21명 환자군을 대상으로 중둔근(Gmed), 대퇴막장근(TFL), 전경골근(TA)의 임상경과와 근전도(EMG) 결과의 변화를 조사하였다. 모든 환자의 경우에서 수술 중 신경감시에서는 이상이 없었으나 근전도 검사에서 이상소견이 관찰되었다. 모든 환자들은 수술 후 독립적 보행이 가능하였으나 그 중 9명에게는 경도에서 중등도의 파행이 관찰되었으며 수술 후 2개월째 호전되었다. 중요한 고관절 외전근인 중둔근 및 대퇴막장근은 제 5요추 신경근의 지배를 받으며 충분히 보상이 이루어지지 않은 상태인 급성 추간판 탈출증에서 위약이 나타날 수 있다. 이는 급성기에는 심한 통증으로 인해 잘 알기가 어려우며 수술 후에도 지속되는 파행으로 나타날 수 있다. 일반적인 근전도 검사 및 수술 중 신경 감시에서는 중둔근을 확인하기 어렵고 대개 보존적인 치료로도 잘 회복되나 수술 후에 환자가 불편감을 호소하므로 주의를 요한다.