Dermatomal laser-evoked potentials: a diagnostic approach to the dorsal root. Norm data in healthy volunteers and changes in patients with radiculopathy

We conducted a cross-sectional study of 40 radiculopathy patients in comparison with norm data from healthy subjects using a new electrophysiological method. Early manifestations of dorsal root impairment escape objective diagnosis by conventional somatosensory-evoked potentials due to the overlapping innervation of the affected dermatome by thickly myelinated mechanoreceptive afferents projecting to adjacent intact roots. Evidence suggested less intersegmental overlap for thermonociceptive afferents rendering laser-evoked potentials (LEP) sensitive to monosegmental dorsal root damage. Therefore we used this new method to study acute manifestations of monosegmental dorsal root pathology. Dorsal root function was tested in 12 healthy subjects and 40 sciatica patients by intraindividual interside comparison. Mechanosensibility and thermosensibility were clinically investigated. LEP were induced by moderately painful laser stimuli. The LEP were evaluated by amplitude and latency of the averaged electroencephalogram. Normal interside differences of LEP for amplitude were +/- 22% (lower limb) and +/- 35% (upper limb) and +/- 15 to +/- 16% for latency. Twenty-six patients (65%) showed significant LEP changes, mainly amplitude decreases. Six of these patients exhibited latency prolongations. Clinical testing yielded more frequent pathological results for pain compared to mechanosensibility. The study confirmed our preliminary evidence of LEP sensitivity to objectively document dorsal root impairment in patients suffering from acute monosegmental radiculopathy. This result opens the perspective of electrophysiologically differentiating the presence or absence of dorsal root pathology in patients with similar clinical symptoms but possibly different prognoses, which require different therapies.