plSSN 1738-2262 
elSSN 2093-6729 
Clinical Article
  |   Korean J Spine_11_2_57_61.pdf
Korean J Spine 2014 June;11(2):57-61.
Published online 2014 July 02
Copyright ⓒ 2014 Korean Journal of Spine
Unusual Clinical Presentations of Cervical or Lumbar Dorsal Ramus Syndrome
Shin Jae Kim1, Myeong Jin Ko1, Young Seok Lee1, Seung Won Park1, Young Baeg Kim1, Chan Chung2
1Department of Neurosurgery, College of Medicine, Chung-Ang University, Seoul,
2Department of Neurosurgery, College of Medicine, Dongguk University, Gyungju, Korea
Corresponding Author: Seung Won Park, MD, PhD , Tel: +82-2-6299-3190 , Fax: +82-2-821-8409 , Email:
Objective: Patients with cervical (CDRS) or lumbar dorsal ramus syndrome (LDRS) are characterized by neck or low back pain with referred pain to upper or lower extremities. However, we experienced some CDRS or LDRS patients with unusual motor or bladder symptoms. We analyzed and reviewed literatures on the unusual symptoms identified in patients with CDRS or LDRS.
Methods: This study included patients with unusual symptoms and no disorders of spine and central nervous system, a total of 206 CDRS/LDRS patients over the past 3 years. We diagnosed by using double diagnostic blocks for medial branches of dorsal rami of cervical or lumbar spine with 1% lidocaine or 0.5% bupivacaine for each block with an interval of more than 1 week between the blocks. Greater than 80% reduction of the symptoms, including unusual symptoms, was considered as a positive response. The patients with a positive response were treated with radiofrequencyneurotomy.
Results: The number of patients diagnosed with CDRS and LDRS was 86 and 120, respectively. Nine patients (10.5%) in the CDRS group had unusual symptoms, including 4 patients with motor weakness of the arm, 3 patients with tremors, and rotatory torticollis in 2 patients. Ten patients (8.3%) in the LDRS group showed unusual symptoms, including 7 patients with motor weakness of leg, 2 patients with leg tremor, and urinary incontinence in 1 patient. All the unusual symptoms combined with CDRS or LDRS were resolved after treatment.
Conclusion: It seems that the clinical presentationssuch as motor weakness, tremor, urinary incontinence without any other etiologic origin need to be checked for unusual symptoms of CDRS or LDRS.
Keywords: Spinal nervesㆍLow back painㆍNeck painㆍParalysisㆍUrinary incontinenceㆍTremor
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