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INVESTIGATION OF TRENDELENBURG SIGN AMONG PATIENTS PRESENTING LUMBOSACRAL RADICULAR SYMPTOMS CAUSED BY LUMBAR SPINAL DISEASE: GP137.

Morita, Masahiro1; Miyauchi, Akira2

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Spine Journal Meeting Abstracts: October 2011 - Volume - Issue - [no page #]
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INTRODUCTION: The purpose of this study is to investigate Trendelenburg sign (Tsign) among patients presenting lumbosacral radicular symptoms caused by lumbar spinal disease.

METHODS: We selected 96 patients who underwent MRI for lumbosacral radicular symptoms, and 84 patients underwent surgery. Patients involved more than two levels or a large lesion that could compress more than two nerve roots of different levels were excluded from this study. 18 patients presented symptoms in both lower extremities, and T‐sign was investigated by their medical records in 114 legs. None had another lesion responsible for positive T‐sign. Definitive diagnosis was disc herniation in 39 patients (including extraforaminal lesion), lateral canal stenosis in 47 patients, lytic spondylolisthesis in 7 patients, and synovial cyst in 3 patients. According to MRI, L4 nerve root was involved in 15 legs (Group L4), L5 nerve root in 88 legs (Group L5), and S1 nerve root in 11 legs (Group S1).

RESULTS: T‐sign were positive for 33% (5/15) in Group L4, 34% (30/88) in Group L5, and 9% (1/11) in Group S1. There were no statistical significant differences for positive T‐sign between these groups. Additional investigation for the patients in Group L4 and S1 revealed that there were statistical significant differences between positive and negative T‐sign in relation to discrepancy between the level of the lesion and neurological findings. Nerve root anomaly was identified in one patient in Group L4 presenting positive T‐sign.

DISCUSSION: The most powerful hip abductor, gluteus medius is supplied by the superior gluteal nerve (L4, 5, and S1), and the L5 nerve root has the strongest representation in this muscle. In case T‐sign is positive caused by lumbar spinal disease at the level of L4 or S1 nerve root involvement, this suggests there are changes in segment of lumbosacral nerve root.

© 2011 Lippincott Williams & Wilkins, Inc.