Annals of Rehabilitation Medicine

"Thoracolumbar"

Case Report

Thoracolumbar Junction Syndrome Accompanying Renal Artery Stenosis: A Case Report: Kyudong Noh, Jong Burm Jung, Jeong Won Seong, Doh-Eui Kim, Dongrak Kwon, Yuntae Kim; Ann Rehabil Med 2020;44(1):85-89. Published online February 29, 2020; DOI: https://doi.org/10.5535/arm.2020.44.1.85

Abstract
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Flank pain is a common reason for visits to the emergency room. The most common reason warranting hospital visits are urology-related problems. However, there are many other causes, such as musculoskeletal lesions, that difficult to achieve a correct diagnosis. Here, we describe a rare case of flank pain caused by thoracolumbar junction syndrome, accompanying renal artery stenosis. A 54-year-old male with hypertension presented with severe left flank pain for 1 week. Initially, he was diagnosed with left renal artery stenosis by computed tomography and decreased renal function on renal scan (Tc-99m DTPA). Although a stent was inserted into the left renal artery, flank pain persisted with only minor improvement. Through detailed physical examination, he was finally diagnosed with thoracolumbar junction syndrome. After three injections in the left deep paravertebral muscles at the T10–T12 levels, flank pain completely ceased. Clinicians must consider thoracolumbar junction syndrome, when treating patients with flank pain.

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Original Article

Can MRI Findings Help to Predict Neurological Recovery in Paraplegics With Thoracolumbar Fracture?: Joonchul Lee, Seong-Eun Koh, Heeyoune Jung, Hye Yeon Lee, In-Sik Lee; Ann Rehabil Med 2015;39(6):922-930. Published online December 29, 2015; DOI: https://doi.org/10.5535/arm.2015.39.6.922

Abstract
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Objective

To evaluate the usefulness of various magnetic resonance imaging (MRI) findings in the prognosis of neurological recovery in paraplegics with thoracolumbar fracture using association analysis with clinical outcomes and electrodiagnostic features.

Methods

This retrospective study involved 30 patients treated for paraplegia following thoracolumbar fracture. On axial and sagittal T2-weighted MRI scans, nerve root sedimentation sign, root aggregation sign, and signal intensity changes in the conus medullaris were independently assessed by two raters. A positive sedimentation sign was defined as the absence of nerve root sedimentation. The root aggregation sign was defined as the presence of root aggregation in at least one axial MRI scan. Clinical outcomes including the American Spinal Injury Association impairment scale, ambulatory capacity, and electrodiagnostic features were used for association analysis.

Results

Inter-rater reliability of the nerve root sedimentation sign and the root aggregation sign were κ=0.67 (p=0.001) and κ=0.78 (p<0.001), respectively. A positive sedimentation sign was significantly associated with recovery of ambulatory capacity after a rehabilitation program (χ²=4.854, p=0.028). The presence of the root aggregation sign was associated with reduced compound muscle action potential amplitude of common peroneal and tibial nerves in nerve conduction studies (χ²=5.026, p=0.025).

Conclusion

A positive sedimentation sign was significantly associated with recovery of ambulatory capacity and not indicative of persistent paralysis. The root aggregation sign suggested the existence of significant cauda equina injuries.