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Physical Medicine and Rehabilitation (87)
Author(s) -
Haig A.J.,
Yamakawa K.,
Hudson D.M.
Publication year - 2001
Publication title -
pain practice
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.899
H-Index - 58
eISSN - 1533-2500
pISSN - 1530-7085
DOI - 10.1111/j.1533-2500.2001.1011-87.x
Subject(s) - medicine , lumbar , electromyography , lesion , low back pain , cauda equina , magnetic resonance imaging , lumbar vertebrae , anatomy , radiology , surgery , physical medicine and rehabilitation , spinal cord , pathology , alternative medicine , psychiatry
Paraspinal electromyography in high lumbar and thoracic lesions. (University of Michigan, Ann Arbor, MI) Am J Phys Med Rehabil 2000;79:336–342. This study aimed to use needle electromyography in the paraspinal muscles to localize the root level of a radiculopathy. Nine cases of clinically proven, isolated high lumbar or thoracic disk herniations of patients who underwent MiniPM were collected. Four were from a prospective study of 114 persons with low back pain (MiniPM had 100% sensitivity to magnetic resonance imaging‐documented high disks). In the most medial “S” column, mean MiniPM scores were 0.7 for the level above the radiologically documented lesion (3.1 at the lesion and 1.6, 1.6, and 1.1 at the 3 spinous processes below the lesion). Similar numbers were obtained in the “M” column (slightly lateral), with no significant differences between S and M. Differences were significant between and at the level of the lesion for S ( P < 0.06) and M ( P < 0.01), and between the lesion level and 3 levels below for the M column ( P < 0.01). Conclude that paraspinal electromyography has a higher than previously reported sensitivity for high lumbar lesions. Electromyography using MiniPM can localize some radiculopathies. The individual cases suggest that, consistent with the anatomy of the caudi equina, thoracic lesions and lateral lumbar lesions denervate only at 1 level, but more central lumbar lesions also denervate distally innervated paraspinal muscles. Comment by Miles Day, MD. This study is designed to assess the sensitivity of many MiniPM for higher‐level rediculopathies, ie, lower thoracic and high lumbar, and to determine if findings are specific to the root level involved. The MiniPM is thought to assess the multifidus portion of the paraspinal muscles that are innervated from L2 to the sacrum. The clinical protocol tests the paraspinal extensively and provides a numerica score, thus eliminating some subjectivity of the EMG. The study demonstrates that MiniPM has good sensitivity for high lumbar and thoracic lesions and provides information on the level of the lesion independent of limb EMG. After reviewing the study, I agree with the authors that MiniPM is in itself not diagnostic for radiculopathy, but is only an additional test to help support other neuro physiological studies when evaluating for radiculopathy. It is not specific for diagnosing radiculopathy.