Low back pain electrodiagnostic test

OBJECTIVES: Performed by thousands of specialists and researched for >60 yrs, electrodiagnostic testing rates poorly in evidence-based guidelines in part because there are no valid masked research studies. This study assesses whether the electrodiagnostic examination can be adequately masked. DESIGN: Prospective, controlled, masked trial. A total of 150 persons aged 55-80 yrs, thought clinically to be asymptomatic (n = 32), with low back pain (n = 46), or with spinal stenosis (n = 63), underwent needle electromyography and nerve conduction studies by specialists in physical medicine and rehabilitation who were not permitted to ask any clinical information or to perform a formal examination...

This review of radiological and other procedures used in the diagnosis of (chronic) low-back pain is not intended to provide a complete evaluation of the methods employed, because the validity, specificity and sensitivity of the various diagnostic measures are the subject of so much controversy that a comprehensive discussion would be beyond the scope of the present overview. The choice of method depends not only on the clinical symptoms but also on the localisation of the pain, the aetiology of which may also be related to the age of the patient...

STUDY DESIGN: Multivariate logistic regression techniques were used to develop a composite nerve conduction measurement that detects lumbosacral (L5, S1, or both) nerve root compression. OBJECTIVES: To evaluate the diagnostic efficacy of a composite nerve conduction measurement for detection of lumbosacral nerve root compression. SUMMARY OF BACKGROUND DATA: Nerve root involvement is characterized by clinical abnormalities and confirmed by radiologic and electrodiagnostic studies...

STUDY DESIGN: Three cases of hysterical paralysis are reported and the literature is reviewed. OBJECTIVE: To report and discuss three cases of psychogenic paraplegia in order to increase the awareness and assist in the diagnosis and treatment of this uncommon disorder. SUMMARY OF BACKGROUND DATA: Hysterical paralysis, a form of conversion disorder, is an uncommon psychogenic, nonorganic loss of motor function precipitated by a traumatic event...

STUDY DESIGN: A retrospective EMG study with blinded radiologic measurement was conducted. OBJECTIVE: To determine the relation among spinal measurements on MRI, paraspinal denervation, and age in patients referred for electrodiagnostic and radiologic evaluation of low back pain. SUMMARY OF BACKGROUND DATA: Spinal pathology, including disc herniation and spinal stenosis, can cause denervation of the paraspinal muscles. Various mechanisms including direct compression, inflammation, vascular compromise, and mechanical stretch of the posterior primary ramus may play a role in denervation...

Using routine electrodiagnostic procedures, the authors searched for physiologic evidence of nerve root compromise in patients with chronic mechanical perturbation to the lumbar spine. They examined 37 patients with spondylolisthesis and various degrees of degenerative changes in the lumbar canal. Clinical and neurophysiologic findings were compared with data obtained from 36 healthy persons. The soleus H-reflex appeared to be a sensitive indicator of sensory fiber compromise at the S1 root level, because changes correlated well with the focal sensory signs and preceded clinical and electromyographic signs of motor root involvement...

OBJECTIVE: To test the ability of two different clinical practice guideline formats to influence physician ordering of electrodiagnostic tests in low back pain. DATA SOURCES/STUDY DESIGN: Randomized controlled trial of the effect of practice guidelines on self-reported physician test ordering behavior in response to a series of 12 clinical vignettes. Data came from a national random sample of 900 U.S. neurologists, physical medicine physicians, and general internists...

H reflex is known as a useful electrodiagnostic test in the diagnosis of S1 radiculopathy. But, only the latency difference has been the useful parameter by previously published conventional method. Under the assumption that the constant appearance of initial negative biphasic H wave is critical to study H reflex using parameters such as amplitude, area and shape, we developed a new method using parameters such as amplitude, area and shape. To validate our assumption and to compare the diagnostic values between the conventional method and the new one, we studies H reflex in 330 subjects...

OBJECTIVE: To evaluate the use of the Hmax/Mmax (H/M) ratio as an outcome measure for acute low back pain and to determine the change of this ratio in acute low back pain patients treated with spinal manipulation. DESIGN: Randomized clinical trial. SETTING: Chiropractic college teaching clinic. PATIENTS: Thirty-six patients with acute low back pain (pain of less than 2 wk duration) were referred by clinicians of the teaching clinic...

OBJECTIVE: The usefulness of electrodiagnostic testing by the primary care provider is shown in two cases of suspected compression-type neural lesions of the lumbar spine. CLINICAL FEATURES: A 54-yr-old female with acute lumbar spine pain that radiated into the hip and a 26-yr-old male with sharp gluteal pain that radiated into the thigh and ankle were admitted into an inpatient care facility for intensive therapy. Plain film radiographs were obtained initially...

In the diagnosis of low back pain, the presence of a high percentage of false positive findings on radiologic imaging studies has lead to a more definitive role for electrodiagnosis as a confirmatory test. The paraspinal muscles are a crucial part of the electrodiagnostic examination for radiculopathy. To date, no technique for paraspinal evaluation has been validated. Based on previously documented anatomical techniques, we have designed a method of paraspinal examination termed "paraspinal mapping" (PM). Electromyographic (EMG) needles are placed in five carefully chosen locations and inserted in multiple directions...

OBJECTIVE: This study examined patterns of diagnostic test use for patients with low back pain. Three specific questions were addressed: 1) What tests do physicians recommend for patients with 3 common types of low back pain? 2) Do physicians in various specialties differ in the tests they would order? and 3) How appropriate are physicians' choices of tests, based on current medical knowledge and expert recommendations? METHODS: A stratified national random sample of 2,604 physicians in 8 specialties was mailed questionnaires asking about the tests they would order for hypothetical patients with acute back pain, sciatica, or chronic low back pain...

Back pain is a very common disorder, and low back pain has many causes. The clinical features of a single identifiable cause of back pain, lumbar disk disease, are summarized in this article. The hallmark of disk disease is single nerve root involvement, which often produces back pain and usually causes even more intense leg pain. Physical findings include sensory loss in a specific nerve root dermatome, weakness and atrophy of the muscle supplied by that nerve root, and reflex changes appropriate to the specific nerve root...

One hundred patients with complaints of low-back pain and leg pain, consistent with a diagnosis of sciatica, were evaluated. All patients had complaints for longer than 6 months and had recently undergone electrodiagnostic testing and computed tomography (CT). Correlation was made between symptoms, straight leg raising, clinical neurological deficits, electrodiagnostic and CT findings. The radiation of pain above or below the knee and pain on straight leg raising did not show a high correlation with each other or with neurological deficits or CT findings...