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Do L5 and s1 nerve root compressions produce radicular pain in a dermatomal pattern?

PainSci » bibliography » Taylor et al 2013
updated
Tags: diagnosis, anatomy, neurology, spine, back pain, sciatica, leg, pain problems, butt, hip, limbs

Three articles on PainSci cite Taylor 2013: 1. The Complete Guide to Low Back Pain2. Shin Splints Treatment, The Complete Guide3. The Complete Guide to Neck Pain & Cricks

original abstract Abstracts here may not perfectly match originals, for a variety of technical and practical reasons. Some abstacts are truncated for my purposes here, if they are particularly long-winded and unhelpful. I occasionally add clarifying notes. And I make some minor corrections.

STUDY DESIGN: Observational case series.

OBJECTIVE: To compare the pattern of distribution of radicular pain with published dermatome charts.

SUMMARY OF BACKGROUND DATA: Dermatomal charts vary and previous studies have demonstrated significant individual subject variation.

METHODS: Patients with radiologically and surgically proven nerve root compression (NRC) caused by prolapsed intervertebral disc completed computerized diagrams of the distribution of pain and pins and needles. Ninety-eight patients had L5 compressions and 83 had S1 compressions.

RESULTS: The distribution of pain and pins and needles did not correspond well with dermatomal patterns. Of those patients with L5 NRC, only 22 (22.4%) recorded any hits on the L5 dermatome on the front, and only 60 (61.2%) on the back with only 13 (13.3%) on both. Only 1 (1.0%) patient placed more than 50% of their hits within the L5 dermatome. Of those patients with S1 NRC, only 3 (3.6%) recorded any hits on the S1 dermatome on the front, and only 64 (77.1%) on the back with only 15 (18.1%) on both. No patients placed more than 50% of their hits within the S1 dermatome. Regarding pins and needles, 27 (29.7%) patients with L5 NRC recorded hits on the front alone, 27 (29.7%) on the back alone, and 14 (15.4%) on both. Nineteen (20.9%) recorded more than 50% of hits within the L5 dermatome. Three (3.6%) patients with S1 NRC recorded hits on the front alone, 44 (53.0%) on the back alone, and 18 (21.7%) on both. Twelve (14.5%) recorded more than 50% of hits within the S1 dermatome.

CONCLUSION: Patient report is an unreliable method of identifying the anatomical source of pain or paresthesia caused by nerve root compression.

LEVEL OF EVIDENCE: 4.

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