Quantification of thermal asymmetry

Part 2: Application in low-back pain and sciatica

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✓ Temperature differences between the lower extremities were measured using a computerized thermometric scanning system in order to compare the degree of thermal asymmetry in 144 patients with low-back pain. The patients displayed highly significant thermal asymmetries, with the involved limb being cooler (p < 0.001). When asymmetries exceeded 1 standard deviation from the mean temperature of homologous regions measured in 90 normal control subjects, the positive predictive value of thermometry in detecting root impingement was 94.7% and the specificity was 87.5%. These values indicate that calculation of temperature asymmetry is particularly effective in evaluating reported pain in psychosocially affected patient populations in whom the chance of positive myelography or impaired root function is low. In this group of patients, thermometric study provides physicians with important information for proper decision making. The test can be performed to avoid more invasive and probably less revealing diagnostic or exploratory surgical procedures.

Article Information

Address reprint requests to: Sumio Uematsu, M.D., Department of Neurosurgery, Meyer 2-147, The Johns Hopkins Hospital, 600 North Wolfe Street, Baltimore, Maryland 21205.

© AANS, except where prohibited by US copyright law.

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Figures

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    The three grades of spinal nerve involvement seen in myelography. Grade 1: The spinal root is displaced but is filled with contrast medium. Grade 2: A single root is disrupted. Grade 3: There is disruption of two or more roots by the herniated nucleus pulposus or other pathology.

  • View in gallery

    Oblique view of the lumbosacral myelogram showing the medially displaced L-5 root on the left (white arrow). No other root is involved. This case is classified as Grade 1 involvement by our criteria.

  • View in gallery

    Absolute temperature fluctuates slightly but the thermal asymmetry (the left foot averaged 0.8°C colder) is unchanged, as shown by readings repeated every 5 minutes for 1 hour. This consistent observation was seen in normal subjects as well as patients. External stress, such as cooling the arm, does not affect the reproducibility of thermal asymmetry for the feet.

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