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Clinical Predictors of EMG-confirmed Cervical and Lumbosacral Radiculopathy

Published online by Cambridge University Press:  23 September 2014

Ali Hassan ,
Bilal Hameed ,
Muhammad Islam ,
Bhojo Khealani ,
Mustafa Khan  and
Saad Shafqat
Ali Hassan
Affiliation:
Section of Neurology, Department of Medicine, Aga Khan University Medical College, Karachi, Pakistan
Bilal Hameed
Affiliation:
Section of Neurology, Department of Medicine, Aga Khan University Medical College, Karachi, Pakistan
Muhammad Islam
Affiliation:
Section of Neurology, Department of Medicine, Aga Khan University Medical College, Karachi, Pakistan
Bhojo Khealani
Affiliation:
Section of Neurology, Department of Medicine, Aga Khan University Medical College, Karachi, Pakistan
Mustafa Khan
Affiliation:
Section of Neurology, Department of Medicine, Aga Khan University Medical College, Karachi, Pakistan
Saad Shafqat
Affiliation:
Section of Neurology, Department of Medicine, Aga Khan University Medical College, Karachi, Pakistan
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Abstract

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Background:

Electromyography (EMG) for suspected cervical or lumbosacral root compression is often negative, producing expense and physical discomfort that could have been avoided. To improve patient selection for testing, we sought to identify clinical features that would accurately predict presence of radiculopathy on EMG.

Methods:

Adult patients consecutively evaluated for suspected cervical or lumbosacral root compression at an academic clinical neurophysiology laboratory were prospectively enrolled. Presence of clinical features suggesting root disease (neck or back pain, dermatomal pain or numbness, myotomal weakness, segmental reflex loss, and straight leg-raising) was recorded prior to testing. EMG examination to confirm root compression was conducted per standard protocols. Analysis was based on computation of sensitivity, specificity, predictive values, and accuracy.

Results:

A total of 200 patients (55% male; mean age 46.4 years; 38% suspected of cervical and 62% of lumbosacral disease) were included. EMG evidence of root disease was detected in 31% of cervical and 62% of lumbosacral referrals. Dermatomal pain was the most sensitive, and segmental reflex loss and myotomal weakness the most specific individual predictors of root disease. Combined presence of dermatomal pain or numbness with segmental reflex loss and myotomal weakness approached specificities of 78% (lumbosacral disease) and 99% (cervical disease). In all cases, myotomal weakness was the most accurate predictor of root disease.

Conclusion:

The diverse symptoms and signs of cervical and lumbosacral root compression predict a positive electrodiagnosis of radiculopathy with varying degrees of accuracy, and may be used to guide patient selection for EMG testing.

Résumé:

Résumé:Contexte:

L'électromyogramme (EMG) effectué lorsque l'on soupçonne une compression radiculaire cervicale ou lombo-sacrée est souvent négatif, ce qui engendre des coûts et un inconfort qui pourraient être évités. Nous avons voulu identifier les caractéristiques cliniques qui prédisent de façon fiable la présence d'une radiculopathie à l'EMG afin d'améliorer la sélection des patients soumis à ce test.

Méthode:

Des patients adultes évalués de façon consécutive, chez qui on soupçonnait une compression radiculaire cervicale ou lombo-sacrée dans un laboratoire de neurophysiologie clinique en milieu universitaire, ont été recrutés de façon prospective. La présence de manifestations cliniques suggérant une maladie radiculaire (douleur cervicale ou dorsale, douleur ou engourdissement au niveau d'un dermatome, faiblesse au niveau d'un myotome, perte de réflexe segmentaire et de soulèvement de la jambe en extension) a été noté avant le test. L'EMG effectué pour confirmer la compression radiculaire a été effectué selon le protocole standard. L'analyse visait à déterminer la sensibilité, la spécificité, la valeur prédictive et l'exactitude du test.

Résultats:

Deux cent patients dont l'âge moyen était de 46,4 ans (55% d'hommes; maladie cervicale soupçonnée chez 38% et lombo-sacrée chez 62%) ont été inclus dans l'étude. Des signes de maladie radiculaire ont été notés chez 31% des patients référés pour une pathologie cervicale et chez 62% de ceux référés pour une pathologie lombo-sacrée. La douleur au niveau d'un dermatome était le symptôme le plus sensible et la perte de réflexe segmentaire et la faiblesse au niveau d'un myotome étaient les facteurs individuels de prédiction les plus spécifiques de la maladie radiculaire. La présence combinée de douleur ou d'engourdissement au niveau d'un dermatome, avec une perte de réflexe segmentaire et une faiblesse au niveau d'un myotome avaient une spécificité de près de 78% pour la maladie lombo-sacrée et de près de 99% pour la maladie cervicale. Chez tous les cas, la faiblesse au niveau d'un myotome était le facteur de prédiction le plus exact de la maladie radiculaire.

Conclusion:

Les divers symptômes et signes de compression radiculaire cervicale et lombo-sacrée prédisent un électrodiagnostic positif de radiculopathie avec un degré variable d'exactitude et peuvent être utilisés pour guider le choix des patients soumis à un EMG.

Type
Original Article
Information
Canadian Journal of Neurological Sciences , Volume 40 , Issue 2 , March 2013 , pp. 219 - 224
Copyright
Copyright © The Canadian Journal of Neurological 2013

References

1. Mixter, W, Barr, J. Rupture of the intervertebral disc with involvement of the spinal canal. N Engl J Med. 1934;211:210–4.Google Scholar
2. Tarulli, AW, Raynor, EM. Lumbosacral radiculopathy. Neurol Clin. 2007;25:387–405.CrossRefGoogle ScholarPubMed
3. Roth, D, Mukai, A, Thomas, P, Hudgins, TH, Alleva, JT. Cervical radiculopathy. Dis Mon. 2009;55:737–56.Google Scholar
4. Wilbourn, AJ, Aminoff, MJ. AAEM minimonograph 32: the electrodiagnostic examination in patients with radiculopathies. Muscle Nerve. 1998;21:1612–31.3.0.CO;2-0>CrossRefGoogle ScholarPubMed
5. American Association of Electrodiagnostic Medicine, So, YT. Guidelines in electrodiagnostic medicine. Practice parameter for needle electromyographic evaluation of patients with suspected cervical radiculopathy. Muscle Nerve. 1999;Suppl: S209–21.Google Scholar
6. Cho, SC, Ferrante, MA, Levin, KH, Harmon, RL, So, YT. Utility of electrodiagnostic testing in evaluating patients with lumbosacral radiculopathy: an evidence-based review. Muscle Nerve. 2010;42:276–82.Google Scholar
7. Fuller, G. How to get the most out of nerve conduction studies and electromyography. J Neurol Neurosurg Psychiatry. 2005;76 Suppl II:ii41–6.Google Scholar
8. Levin, KH, Maggiano, HJ, Wilbourn, AJ. Cervical radiculopathies: comparison of surgical and EMG localization of single root lesions. Neurology. 1996;46:1022–5.CrossRefGoogle ScholarPubMed
9. Lauder, TD, Dillingham, TR, Huston, CW, Chang, AS, Belandres, PV. Lumbosacral radiculopathy screen. Optimizing the number of muscles studies. Am J Phys Med Rehabil. 1994;73:394–402.Google Scholar
10. Radhakrishnan, K, Litchy, WJ, O’Fallon, WM, Kurland, LT. Epidemiology of cervical radiculopathy. A population-based study from Rochester, Minnesota, 1976 through 1990. Brain. 1994;117:325–35.Google Scholar
11. Porta, M, editor. A Dictionary of Epidemiology. 5th ed. New York: Oxford University Press; 2008.Google Scholar
12. Nardin, RA, Patel, MR, Gudas, TF, Rutkove, SB, Raynor, EM. Electromyography and magnetic resonance imaging in the evaluation of radiculopathy. Muscle Nerve. 1999;22:151–5.3.0.CO;2-B>CrossRefGoogle ScholarPubMed
13. Coster, S, de Bruijn, SFTM, Tavy, DLJ. Diagnostic value of history, physical examination and needle electromyography in diagnosing lumbosacral radiculopathy. J Neurol. 2010;257:332–7.CrossRefGoogle ScholarPubMed
14. Jensen, MC, Brant-Zawadski, MN, Obuchowski, N, Modic, MT, Malkasian, D, Ross, JS. Magnetic resonance imaging of the spine in people without back pain. N Engl J Med. 1994;331:69–73.Google Scholar
15. Robinson, LR. Electromyography, magnetic resonance imaging, and radiculopathy: it’s time to focus on specificity. Muscle Nerve. 1999;22:149–50.Google Scholar
16. Alrawi, MF, Khalil, NM, Mitchell, P, Hughes, SP. The value of neurophysiological and imaging studies in predicting outcome in the surgical treatment of cervical radiculopathy. Eur Spine J. 2007;16:495–500.CrossRefGoogle ScholarPubMed
17. Lauder, TD. Physical examination signs, clinical symptoms, and their relationship to electrodiagnostic findings and the presence of radiculopathy. Phys Med Rehabil Clin N Am. 2002;13:451–67.Google Scholar
18. Wainner, RS, Fritz, JM, Irrgang, JJ, Boninger, ML, Delitto, A, Allison, S. Reliability and diagnostic accuracy of the clinical examination and patient self-report measures for cervical radiculopathy. Spine. 2003;28:52–62.Google Scholar
19. van der Windt, DA, Simons, E, Piphagen, II, et al. Physical examination for lumbar radiculopathy due to disc herniation in patients with low-back pain. Cochrane Database Syst Rev. 2010;2:CD007431.Google Scholar
20. Lauder, TD, Dillingham, TR, Andary, M, et al. Effect of history and exam in predicting electrodiagnostic outcome among patients with suspected lumbosacral radiculopathy. Am J Phys Med Rehabil. 2000;79:60–8.Google Scholar
21. Lauder, TD, Dillingham, TR, Andary, M, et al. Predicting electrodiagnostic outcome in patients with upper limb symptoms: are the history and physical examination helpful? Arch Phys Med Rehabil. 2000;81:436–41.Google Scholar