Comparison of diagnostic indices of MRI and EMG in diagnosis of lumbar radiculopathy
DOI:
https://doi.org/10.22122/cdj.v2i1.61Keywords:
Radiculopathy, Magnetic Resonance Imaging, ElectromyographyAbstract
BACKGROUND: lumbosacral radiculopathy is one of the most common disorders that can be examined by neurologists. Electromyography (EMG) and magnetic resonance imaging (MRI) are used to inspect this disease; however, the application of MRI and EMG in patients with back pain is still under study. This study was designed and implemented to compare the diagnostic values of MRI and EMG in the diagnosis of lumbar radiculopathy.
METHODS: This was cross-sectional study which included 62 patients with suspected lumbosacral radiculopathy in a referral neurology clinic in Sanandaj, Iran, in 2009-2010. EMG was considered as the gold standard test. Inclusion criteria were being older than 20 years of age, and suffering from back pain or radicular pain in the lower limbs for more than four weeks. Data were entered into SPSS software and the diagnostic indices and agreement were calculated.
RESULTS: The percentage of agreement between MRI and EMG results were calculated as 80.6%. The sensitivity of MRI compared with EMG at different levels was calculated between 44.4% and 79.6% and its specificity was calculated between 46.1% and 94.3%. In total, sensitivity and specificity of MRI were 68.9% and 86.3%, respectively. The Lasègue's sign, used for detection of disc herniation, had the sensitivity, specificity, and positive and negative predictive value of 28.8%, 50%, 75%, and 11.9%, respectively.
CONCLUSION: MRI and EMG tests have no superiority over one another for the evaluation of lumbar radiculopathy and it is necessary to do both. The Lasègue's sign is also not an appropriate test for detection of lumbar spine disc herniation, and it is not helpful in diagnosing or ruling out the disease.
References
Schochat T, Jackel WH. Prevalence of low back pain in the population. Rehabilitation (Stuttg) 1998; 37(4): 216-23.
Prevalence of disabilities and associated health conditions among adults--United States, 1999. MMWR Morb Mortal Wkly Rep 2001; 50(7): 120-5.
Lee-Robinson A, Lee AT. Clinical and Diagnostic Findings in Patients with Lumbar Radiculopathy and Polyneuropathy. AmericAn JournAl of clinic Almedicine 2010; 7(2): 80-5.
Tarulli AW, Raynor EM. Lumbosacral radiculopathy. Neurol Clin 2007; 25(2): 387-405.
Bertilson BC, Brosjo E, Billing H, Strender LE. Assessment of nerve involvement in the lumbar spine: agreement between magnetic resonance imaging, physical examination and pain drawing findings. BMC Musculoskelet Disord 2010; 11: 202.
Ash LM, Modic MT, Obuchowski NA, Ross JS, Brant-Zawadzki MN, Grooff PN. Effects of diagnostic information, per se, on patient outcomes in acute radiculopathy and low back pain. AJNR Am J Neuroradiol 2008; 29(6): 1098-103.
Suri P, Hunter DJ, Katz JN, Li L, Rainville J. Bias in the physical examination of patients with lumbar radiculopathy. BMC Musculoskelet Disord 2010; 11: 275.
Pease WS, Lew HL, Johnson EW. Johnson's Practical Electromyography. Philadelphia, PA: Lippincott Williams and Wilkins; 2007.
Koushan A, Sadat MM, Golbakhsh MR, Siavashi B, Mehran S, Tajik A. The accommodation of EMG and MRI findings in patients with radicular low back pain. Tehran Univ Med J 2010; 68(5): 291-4.
Hsu PS, Armon C, Levin K. Lumbosacral radiculopathy: Pathophysiology, clinical features, and diagnosis [Online]. 2011; Available from: URL: http://www.uptodate.com/contents/lumbosacral-radiculopathy-pathophysiology-clinical-features-and-diagnosis
Reza Soltani Z, Sajadi S, Tavana B, Akbarzadeh M, Emadi A, Mahmudabadi A. Camparison of MRI & Electrodiagnostic study in evaluation of patients with clinical radiculopathy in 501 army hospital, 2008-2009. J Army Univ Med Sci I R Iran 2010; 8(2): 98-103. [In Persian].
Dillingham TR. Electrodiagnostic approach to patients with suspected radiculopathy. Phys Med Rehabil Clin N Am 2002; 13(3): 567-88.
Haig AJ, Geisser ME, Tong HC, Yamakawa KS, Quint DJ, Hoff JT, et al. Electromyographic and magnetic resonance imaging to predict lumbar stenosis, low-back pain, and no back symptoms. J Bone Joint Surg Am 2007; 89(2): 358-66.
Kuruoglu R, Oh SJ, Thompson B. Clinical and electromyographic correlations of lumbosacral radiculopathy. Muscle Nerve 1994; 17(2): 250-1.
Albeck MJ, Taher G, Lauritzen M, Trojaborg W. Diagnostic value of electrophysiological tests in patients with sciatica. Acta Neurol Scand 2000; 101(4): 249-54.
Nafissi Sh, Shahram Niknam Sh, Hosseini SS. Electrophysiological evaluation in lumbosacral radiculopathy. Iran J Neurol 2012; 11(3): 83-6.
Nardin RA, Patel MR, Gudas TF, Rutkove SB, Raynor EM. Electromyography and magnetic resonance imaging in the evaluation of radiculopathy. Muscle Nerve 1999; 22(2): 151-5.
Donofrio PD, Albers JW. AAEM minimonograph #34: polyneuropathy: classification by nerve conduction studies and electromyography. Muscle Nerve 1990; 13(10): 889-903.
Modic MT, Obuchowski NA, Ross JS, Brant-Zawadzki MN, Grooff PN, Mazanec DJ, et al. Acute low back pain and radiculopathy: MR imaging findings and their prognostic role and effect on outcome. Radiology 2005; 237(2): 597-604.