Diagnostic value of different neurophysiological methods in the assessment of lumbar nerve root lesions

• Published in: Archives of physical medicine and rehabilitation Vol. 78; no. 5; pp. 518 - 520
• Main Authors: Braune, Hans-J., Wunderlich, Michael T.
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.05.1997; Elsevier
• Subjects: Adult; Aged; Aged, 80 and over; Biological and medical sciences; Electrodiagnosis. Electric activity recording; Electromyography; Evoked Potentials, Somatosensory; Female; Humans; Investigative techniques, diagnostic techniques (general aspects); Male; Medical sciences; Middle Aged; Muscle, Skeletal - innervation; Nervous system; Neural Conduction; Peripheral Nervous System Diseases - diagnosis; Prospective Studies; Sensitivity and Specificity; Spinal Nerve Roots - physiopathology; Human; Nervous system diseases; Lumbar spine; Exploration; Spine disease; Peripheral neuropathy; Spinal root; Prospective; Electrodiagnosis; Electromyography; Lesion; Somatosensory evoked potential; Spinal cord disease
• ISSN: 0003-9993; 1532-821X
• DOI: 10.1016/S0003-9993(97)90167-2

Objective: To investigate the sensitivity of a combination of different neurophysiological testing methods in patients with lumbar nerve root lesions. Design and Setting: A prospective study was carried out in an electrodiagnosis laboratory on 57 patients with clinically proven lumbar radiculopathies. Patients and Interventions: On 9 patients with L4 nerve root lesions, 31 patients with L5 nerve root lesions, and 17 patients with S 1 nerve root lesions, extensive electromyography (EMG), nerve conduction studies, F-wave-deviations, and somatosensory evoked potentials (SEPs) were performed. Results: In 93% of all patients, a pathological neurophysiological result was found. In L4 nerve root lesions, EMG was abnormal in 89%, dermatome SEPs were abnormal in 67%, and F-wave latencies were abnormal in 44%. In L5 nerve root lesions, a pathological result was found on EMG in 87%, in peroneus SEPs in 67%, and in F-wave latencies in 66%. In S1 nerve root lesions, the most sensitive results were from dermatome SEPs in 64%, followed by EMG in 53% and F-wave latencies in 24%. Nerve conduction study results were always normal. Conclusion: There are segment-specific neurophysiological results. It is possible to enhance testing sensitivity by a combination of different neurophysiologic testing methods. On these grounds, we recommend a segment-specific neurophysiological “diagnosis scheme” to corroborate the clinical diagnosis in lumbar nerve root lesions.