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Orthopaedic Proceedings
Vol. 95-B, Issue SUPP_17 | Pages 26 - 26
1 Apr 2013
THE IMPACT OF SURGERY AND SPINAL INJECTIONS TO RELIEVE LEG PAIN, ON THE CORTICAL CONTROL OF TRUNK AND LEGS
Buisson Y McGregor A Strutton P
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Introduction

Changes in central nervous system (CNS) pathways controlling trunk and leg muscles in patients with low back pain(LBP) and lumbar radiculopathy have been observed and this study investigated whether surgery impacts upon these changes in the long term.

Methods

80 participants were recruited into the following groups: 25 surgery(S), 20 chronic LBP(CH), 14 spinal injection(SI), and 21 controls(C). Parameters of corticospinal control were examined before, at 6, 26 and 52 weeks following lumbar decompression surgery and equivalent intervals. Electromyographic(EMG) activity was recorded from tibialis anterior(TA), soleus(SOL), rectus abdominis(RA), external oblique(EO) and erector spinae(ES) muscles at the T12&L4 levels in response to transcranial magnetic stimulation of the motor cortex. Motor evoked potentials (MEP) and cortical silent periods(cSP) recruitment curves(RC) were analysed.

Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_I | Pages 27 - 27
1 Jan 2012
HOW DO BACK AND LEG PAIN AFFECT CORTICAL MOTOR CONTROL?
Buisson Y Catley M Lopez JG McGregor A Strutton P
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Introduction

Changes in the central nervous system (CNS) pathways controlling trunk and leg muscles in patients with low back pain and radiculopathy have been observed and this study investigated whether surgery impacts upon these changes.

Methods

Parameters of corticospinal control were examined on 3 occasions in 22 patients prior to, at 6 and 26 weeks following lumbar decompression surgery and in 14 control subjects at the same intervals. Electromyographic activity was recorded from tibialis anterior (TA), soleus (SOL), rectus abdominis (RA), external oblique (EO) and erector spinae (ES) muscles at the T12 & L4 levels in response to transcranial magnetic stimulation of the motor cortex.

Orthopaedic Proceedings
Vol. 93-B, Issue SUPP_IV | Pages 489 - 489
1 Nov 2011
THE IMPACT OF SURGERY TO RELIEVE LEG PAIN ON THE CORTICAL CONTROL OF TRUNK AND LEG MUSCLES
Buisson Y Catley M Lopez JG McGregor AH Strutton PH
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Introduction: Changes in the central nervous system (CNS) pathways controlling trunk and leg muscles in patients with low back pain and sciatica have been demonstrated. The aim of this study is to investigate whether these changes are altered by surgery.

Methods: Corticospinal excitability was examined on 2 occasions in 15 patients prior to and 6 weeks following lumbar decompression surgery and 7 control subjects – at the same time intervals. This was achieved by recording electromyographic (EMG) activity from tibialis anterior (TA), soleus (SOL), rectus abdominis (RA), external oblique (EO) and erector spinae (ES) muscles at the T12 & L4 levels in response to transcranial magnetic stimulation (TMS) of the motor cortex.

Results: A significant asymmetry in the cortical silent period (cSP) between the side ipsilateral to the pain and the contralateral side was found pre- but not post surgery in ES at L4 (P=0.012) and SOL (P=0.039). An asymmetry in the size of motor evoked potentials (MEPs) was also found in TA (P=0.009) which was no longer significant post surgery. Abdominal responses could be recorded in 10 subjects, where significant decreases in contralateral cSP in EO (P=0.021) and RA (P=0.033) were found. In controls no significant differences or changes were found.

Discussion: These results show significant asymmetries in the CNS control of trunk and leg muscles in patients prior to surgery to relieve pain which are resolved by the surgery. The degree of change in asymmetry may reflect the variability in surgical outcome. This work is currently ongoing.

Conflicts of Interest: None

Funded by: the DISCS foundation

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