Utility of electrodiagnostic testing in evaluating patients with lumbosacral radiculopathy: An evidence-based review

Stanford University School of Medicine, Stanford, California, USA.
Muscle & Nerve (Impact Factor: 2.28). 08/2010; 42(2):276-82. DOI: 10.1002/mus.21759
Source: PubMed


This is an evidence-based review of electrodiagnostic (EDX) testing of patients with suspected lumbosacral radiculopathy to determine its utility in diagnosis and prognosis. Literature searches were performed to identify articles applying EDX techniques to patients with suspected lumbosacral radiculopathy. From the 355 articles initially discovered, 119 articles describing nerve conduction studies, electromyography (EMG), or evoked potentials in adequate detail were reviewed further. Fifty-three studies met inclusion criteria and were graded using predetermined criteria for classification of evidence for diagnostic studies. Two class II, 7 class III, and 34 class IV studies described the diagnostic use of EDX. One class II and three class III articles described H-reflexes with acceptable statistical significance for use in the diagnosis and confirmation of suspected S1 lumbosacral radiculopathy. Two class II and two class III studies demonstrated a range of sensitivities for use of muscle paraspinal mapping. Two class II studies demonstrated the utility of peripheral myotomal limb electromyography in radiculopathies.

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    • "Most lumbosacral radiculopathies are caused by root compression resulting from intervertebral disc degeneration.1 Lumbosacral nerve root compromise is clinically diagnosed by pain in the lower back that radiates into the leg below the buttocks, and may be confirmed with radiologic and electrodiagnostic studies.2-4 Imaging methods such as magnetic resonance imaging demonstrate structural abnormalities from which neurologic sequelae may be inferred. "
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    ABSTRACT: Electrodiagnostic studies can be used to confirm the diagnosis of lumbosacral radiculopathies, but more sensitive diagnostic methods are often needed to measure the ensuing motor neuronal loss and sympathetic failure. Twenty-six patients with lumbar radiculopathy and 30 controls were investigated using nerve conduction studies, motor unit number estimation (MUNE), testing of the sympathetic skin response (SSR), quantitative electromyography (QEMG), and magnetic resonance myelography (MRM). Using QEMG as the gold standard, the sensitivity and specificity of MUNE for the abductor hallucis longus muscle were 71.4% and 70%, respectively. While they were 75% and 68.8%, respectively, when used MRM as gold standard. The sensitivity and specificity of MUNE for the extensor digitorum brevis muscle were 100% and 84.1%, respectively, when the peroneal motor amplitude as the gold standard. The SSR latency was slightly longer in the patients than in the controls. MUNE is a simple and sensitive test for evaluating autonomic function and for diagnosing lumbosacral radiculopathy in patients. MUNE could be used routinely as a guide for the rehabilitation of patients with radiculopathies. SSR measurements may reveal subtle sympathetic abnormalities in patients with lumbosacral radiculopathy.
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    • "The H-reflex is believed to be a CMAP (Compound Muscle Action Potential) arising from an electrical afferent activation of a monosynaptic reflex arc.[12] The H-reflex is a useful electrophysiological procedure for evaluating the nerve conduction through the entire length of the afferent and efferent pathways, especially at the proximal segment of the peripheral nerve, which is inaccessible by routine surface stimulating and recording techniques,[3] and also suitable for evaluation of the potential entrapment of the S1 nerve root,[456] hence, it is sensitive in detecting mild S1 radiculopathy.[7] In studying S1 radiculopathy, prolonged onset latency and/or absence of the H-reflex on the affected side are the most commonly used measures of the H-reflex.[8910] "
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