Value of paraspinal muscle myography in diagnosing L5 radiculopathy

Cover Page

Cite item

Full Text

Abstract

Introduction. Electromyography (EMG) is an important diagnostic tool for the evaluation of radiculopathy. Since 1990s a paraspinal mapping technique is used, which detects spontaneous activity in paraspinal muscles (PM) at the level of several vertebral segments. This modality seems to be highly conclusive for diagnosing radicular lesions. The main limitation of this method is spontaneous activity dependence on the disease duration.

The aim of the study is to assess if PM EMG with motor unit potential (MUP) analysis is conclusive for diagnosing lumbar radiculopathy.

Materials and methods. The study examined 58 patients (26 men and 32 women) aged 26–73 years with MRI-confirmed symptomatic L5 mono-radiculopathy due to L4–L5 herniated discs. The study assessed the neurological status and needle EMG of m. tensor fasciae latae (TFL) and PM at L4–L5 and L3–L4 levels on both symptomatic and healthy sides immediately before radicular microscopic decompression surgery. Surgery outcomes were evaluated by early and late postoperative questioning.

Results. In PMs of the affected level and side, the average MUP duration was significantly different from opposite MUPs at the higher segment (р < 0.001). At 3-month disease duration, a neurogenic pattern was significantly more frequent in affected PMs (p = 0.031) with neurogenic PM MUP rearrangement in 73.3% of patients. In the TFL (L5), neurogenic changes were reported only in 47.4% of patients. When compared to normal values, significant differences were found in the average duration of TFL MUPs (р = 0.001) and PM MUPs of the affected level and side (р < 0.001) both in patients with motor disorders and those with isolated pain syndrome or sensory disorders.

Conclusions. For diagnosing radiculopathy, the sensitivity of needle PM EMG is 82.6% (48/58; 95% CI 70.6–91.4%). Compared to limb myotome assessment, the highest informative value of PM EMG was reported in patients with the disease duration for up to 3 months. PM EMG was conclusive for diagnosing radicular lesions in patients with isolated pain syndrome or sensory disorders.

About the authors

Ekaterina G. Seliverstova

Sklifosovsky Research Institute for Emergency Medicine

Author for correspondence.
Email: e.seliverstova.md@gmail.com
ORCID iD: 0000-0001-9652-1457
SPIN-code: 2305-7580

neurophysiologist, Clinical neurophysiology laboratory, junior researcher, Emergency neurosurgery department, Sklifosovsky Research Institute for Emergency Medicine, Moscow, Russia

Russian Federation, Moscow

Mikhail V. Sinkin

Sklifosovsky Research Institute for Emergency Medicine; A.I. Yevdokimov Moscow State University of Medicine and Dentistry

Email: mvsinkin@gmail.com
ORCID iD: 0000-0001-5026-0060

D. Sci. (Med.), leading researcher, Emergency neurosurgery deparment, Head, Clinical neurophysiology laboratory, Sklifosovsky Research Institute for Emergency Medicine, Moscow, Russia; Head, Laboratory of invasive neurointerfaces, Research Institute TechnoBioMed, A.I. Yevdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia

Russian Federation, Moscow; Moscow

Anton Y. Kordonsky

Sklifosovsky Research Institute for Emergency Medicine

Email: akord.neuro@mail.ru
ORCID iD: 0000-0001-5344-3970

Cand. Sci. (Med.), neurosurgeon, senior researcher, Emergency neurosurgery department, Sklifosovsky Research Institute for Emergency Medicine, Moscow, Russia

Russian Federation, Moscow

Andrey A. Grin

Sklifosovsky Research Institute for Emergency Medicine; Pirogov Russian National Research Medical University

Email: psolovyeva@yandex.ru
ORCID iD: 0000-0003-3515-8329

D. Sci. (Med.), Corresponding Member of the Russian Academy of Sciences, Head, Scientific department of the emergency neurosurgery, Sklifosovsky Research Institute for Emergency Medicine, Moscow, Russia; professor, Department of fundamental neurosurgery, Pirogov Russian National Research Medical University, Moscow, Russia

Russian Federation, Moscow; Moscow

References

  1. Гуща А.О., Коновалов Н.А., Древаль О.Н. и др. Клинические рекомендации по диагностике и лечению грыж межпозвонковых дисков пояснично-крестцового отдела. М.; 2014. 20 с. Gushcha A.O., Konovalov N.A., Dreval O.N. Clinical recommendations for the diagnosis and treatment of hernias of intervertebral discs in the lumbosacral region. Moscow; 2014. 20 p.
  2. Парфенов В.А., Яхно Н.Н., Давыдов О.С. и др. Дискогенная пояснично-крестцовая радикулопатия. рекомендации российского общества по изучению боли (РОИБ). Неврология, нейропсихиатрия, психосоматика. 2020;(4):15–24. Parfenov V.A., Yakhno N.N., Davydov O.S. et al. Disco- genic lumbosacral radiculopathy. Recommendations of the Russian Association for the Study of Pain (RSSP). Neurology, Neuropsychiatry, Psychosomatics. 2020;12(4):15–24. doi: 10.14412/2074-2711-2020-4-15-24
  3. Plastaras C.T. Electrodiagnostic challenges in the evaluation of lumbar spinal stenosis. Phys. Med. Rehabil. Clin. N. Am. 2003;14(1):57–69. doi: 10.1016/s1047-9651(02)00050-5
  4. Бородулина И.В., Мухина А.А., Чесникова Е.И. Особенности применения инструментальных методов оценки функционального состояния мышечных групп пояснично-крестцового отдела позвоночника. Вестник восстановительной медицины. 2021;20(5):65–72. Borodulina I.V., Mukhina A.A., Chesnikova E.I. Features of the application of instrumental methods for lumbosacral muscle groups functional state assessing. Bulletin of Rehabilitation Medicine. 2021;20(5):65–72. doi: 10.38025/2078-1962-2021-20-5-65-72
  5. Jarvik J.G., Deyo R.A. Diagnostic evaluation of low back pain with emphasis on imaging. Ann. Intern. Med. 2002;137(7):586–597. doi: 10.7326/0003-4819-137-7-200210010-00010
  6. Крылов В.В., Гринь А.А. Травма позвоночника и спинного мозга. М.; 2014. Krylov V.V., Grin A.A. Trauma of the spine and spinal cord. Moscow; 2014.
  7. Yagci I., Gunduz O.H., Ekinci G. et al. The utility of lumbar paraspinal mapping in the diagnosis of lumbar spinal stenosis. Am. J. Phys. Med. Rehabil. 2009;88(10):843–851. doi: 10.1097/PHM.0b013e3181b333a9
  8. Stein J., Baker E., Pine Z.M. Medial paraspinal muscle electromyography: techniques of examination. Arch. Phys. Med. Rehabil. 1993;74(5):497–500. doi: 10.1016/0003-9993(93)90113-o
  9. Kurt S., Kutlu G., Gömceli Y.B., Kuruoğlu H.R. Diagnostic sensitivity of paraspinal needle EMG in cervical radiculopathy. Gazi Med. J. 2004;15(1):19–22.
  10. Селиверстова Е.Г., Синкин М.В., Кордонский А.Ю. и др. Электромио-графические методы в дифференциальной диагностике и обосновании нейрохирургического лечения радикулопатий, вызванных заболеваниями позвоночника. Информативность и методология. Вопросы нейрохирургии имени Н.Н. Бурденко. 2022;86(2):109–118. Seliverstova E.G., Sinkin M.V., Kordonsky A.Yu. et al. Electrodiagnostic evaluation in differential diagnosis and neurosurgical treatment of radiculopathies caused by spine disorders. Diagnostic value and methodology. Burdenko’s Journal of Neurosurgery. 2022;86(2):109–118. (In Russ.). doi: 10.17116/neiro202286021109
  11. Cho S.C., Ferrante M.A., Levin K.H. et al. Utility of electrodiagnostic testing in evaluating patients with lumbosacral radiculopathy: an evidence-based review. Muscle Nerve. 2010;42(2):276–282. doi: 10.1002/mus.21759
  12. Burakgazi A.Z., Kelly J.J., Richardson P. The electrodiagnostic sensitivity of proximal lower extremity muscles in the diagnosis of L5 radiculopathy. Muscle Nerve. 2012;45(6):891–893. doi: 10.1002/mus.23361
  13. Barkhaus P.E. Electronic myoanatomic atlas for clinical electromyography. N.Y; 1997.
  14. Tomasella M., Crielaard J.M., Wang F.C. Dorsal and lumbar paraspinal electromyographic study. Multi-MUP analysis and drawing up normal values in a reference population. Neurophysiol. Clin. 2002;32(2):109–117. doi: 10.1016/s0987-7053(02)00295-2
  15. Shea P.A., Woods W.W., Werden D.H. Electromyography in diagnosis of nerve root compression syndrome. Arch. Neurol. Psychiatry. 1950;64(1):93–104. doi: 10.1001/archneurpsyc.1950.02310250099009
  16. Gough J.G., Koepke G.H. Electromyographic determination of motor root levels in erector spinae muscles. Arch. Phys. Med. Rehabil. 1966;47(1):9–11.
  17. Johnson E.W., Melvin J.L. Value of electromyography in lumbar radiculopathy. Arch. Phys. Med. Rehabil. 1971;52(6):239–243.
  18. Knutsson B. Comparative value of electromyographic, myelographic and clinical-neurological examinations in diagnosis of lumbar root compression syndrome. Acta Orthop. Scand. Suppl. 1961;49:1–135.
  19. Haig A.J., Moffroid M., Henry S. et al. A technique for needle localization in paraspinal muscles with cadaveric confirmation. Muscle Nerve. 1991;14(6):521–526. doi: 10.1002/mus.880140606
  20. Assis R.O., Souza R.R., Araujo R.C. Study on placing electromyography electrodes on lumbar multifidus muscles. J. Morphol. Sci. 2011;28(1):46–51.
  21. Haig A.J., LeBreck D.B., Powley S.G. Paraspinal mapping. Quantified needle electromyography of the paraspinal muscles in persons without low back pain. Spine (Phila Pa 1976). 1995;20(6):715–721.
  22. Haig A.J. Clinical experience with paraspinal mapping. II: A simplified technique that eliminates three-fourths of needle insertions. Arch. Phys. Med. Rehabil. 1997;78(11):1185–1190. doi: 10.1016/s0003-9993(97)90329-4
  23. Date E.S., Mar E.Y., Bugola M.R., Teraoka J.K. The prevalence of lumbar paraspinal spontaneous activity in asymptomatic subjects. Muscle Nerve. 1996;19(3):350–354. doi: 10.1002/(SICI)1097-4598(199603)19:3<350::AID-MUS11>3.0.CO;2-W

Supplementary files

Supplementary Files
Action
1. JATS XML
Download
2. Fig. 1. Procedure for needle EMG of lumbar PMs.

Download (189KB)
Indexing metadata
3. Fig. 2. Combination of clinical manifestations.

Download (147KB)
Indexing metadata
4. Fig. 3. The average MUP duration (ms) in a limb myotome (I), in the L5 PM on the affected side (II), in the contralateral L4 PM (III).

Download (62KB)
Indexing metadata

Copyright (c) 2023 Seliverstova E.G., Sinkin M.V., Kordonsky A.Y., Grin A.A.

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.

This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies