Article

Objectives: To examine the correlation between physical examination parameters, commonly referred to as ''nerve root tension signs,'' and H-reflex latency measurements both pre- and postepidural steroid-bupivacaine (Marcaine) injection, and to propose mechanisms of pain alleviation. Design: Prospective observational, with H-reflex latency measurement and physical examination at baseline and at 10 minutes postinjection. Setting: Physical medicine and rehabilitation practice, outpatient surgical center, and community setting. Participants: Ten consecutively recruited patients (6 women, 4 men; age range, 40-71y) with clinical radiculopathy and compatible magnetic resonance imaging findings, who were unaware of the outcome measures. Interventions: Patients received a fluoroscopically guided, contrast-confirmed, paramedian translaminar lumbar epidural injection of 120mg of methylprednisolone acetate (80mg/mL) and 2.0mL of .25% preservative-free Marcaine. Main Outcome Measures: Seated slump testing (SST), straight-leg raising (SLR), and H-reflex latency were measured bilaterally both pre- and postinjection. Differences were measured by using the paired t test in an A-B design. Results: All SST of the affected (injected) side improved from pre- to postinjection, with 3 patients reporting discordant hamstring pain and 7 reporting no pain. SLR ability increased by an average of 29degrees +/- 12degrees, corresponding to an average relative increase of 54% on the affected side. A statistically significant difference was found (Student t test, P=.02) between pre and post H-reflex latency on the affected side but not when comparing changes between affected and unaffected sides (Student t test, P=0.6). Conclusions: Significant improvements in SST and SLR result from low volume epidural injection of Marcaine, with questionable prolongation of the H-reflex to the gastrocnemiussoleus complex on the affected side.

Langue : ANGLAIS