Electromyographic and magnetic resonance imaging to predict lumbar stenosis, low-back pain, and no back symptoms

Andrew J. Haig, Michael E. Geisser, Henry C. Tong, Karen S J Yamakawa, Douglas J. Quint, Julian T. Hoff, Anthony Chiodo, Jennifer A. Miner, Vaishali Phalke

Research output: Contribution to journalArticle

95 Citations (Scopus)

Abstract

Background: Magnetic resonance imaging is commonly used to diagnose lumbar spinal stenosis. Some persons without symptoms have a small lumbar spinal canal. Electrodiagnosis has been used to diagnose spinal stenosis for over sixty years, but we are aware of no masked, controlled trials of the use of electrodiagnosis for that purpose. This study was performed to evaluate the relationships of magnetic resonance imaging measures and electrodiagnostic data with the clinical syndrome of spinal stenosis. Methods: One hundred and fifty persons between the ages of fifty-five and eighty years old, including asymptomatic volunteers and persons referred for lumbar magnetic resonance imaging, underwent clinical examination, electrodiagnosis, and magnetic resonance imaging. Subjects were excluded if they had neuromuscular disease, sacral cancer, or inadequate test results, which left 126 subjects for the final analysis. The final cohort was divided into three groups - no back pain, mechanical back pain, and clinical spinal stenosis - on the basis of the impression of the examining physician, for whom the results of the magnetic resonance imaging and electrodiagnostic testing were masked. A spine surgeon also reviewed both the imaging and clinical examination data. Results: The examining physician's diagnosis of clinical spinal stenosis was significantly related to the neurological findings on examination (p <0.05) and to the spine surgeon's diagnosis (p <0.001). The diagnosis of clinical spinal stenosis was also significantly related to the presence of fibrillations on electrodiagnostic testing (p ≤ 0.003), the minimum anteroposterior diameter of the spinal canal on the magnetic resonance images (p = 0.016), and the average of the two smallest spinal canal diameters (p = 0.008) on the images. Measurements on magnetic resonance imaging did not differentiate subjects with clinical spinal stenosis from controls better than chance, whereas paraspinal mapping electrodiagnosis scores did. Conclusions: This prospective, controlled, masked study of electrodiagnosis and magnetic resonance imaging for older subjects showed that imaging does not differentiate symptomatic from asymptomatic persons, whereas electrodiagnosis does. We believe that radiographic findings alone are insufficient to justify treatment for spinal stenosis. Level of Evidence: Diagnostic Level IV. See Instructions to Authors for a complete description of levels of evidence.

Original languageEnglish (US)
Pages (from-to)358-366
Number of pages9
JournalJournal of Bone and Joint Surgery - Series A
Volume89
Issue number2
DOIs
StatePublished - Feb 2007
Externally publishedYes

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Spinal Stenosis
Electrodiagnosis
Low Back Pain
Pathologic Constriction
Magnetic Resonance Imaging
Spinal Canal
Back Pain
Spine
Physicians
Neuromuscular Diseases
Volunteers
Magnetic Resonance Spectroscopy

ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine

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Electromyographic and magnetic resonance imaging to predict lumbar stenosis, low-back pain, and no back symptoms. / Haig, Andrew J.; Geisser, Michael E.; Tong, Henry C.; Yamakawa, Karen S J; Quint, Douglas J.; Hoff, Julian T.; Chiodo, Anthony; Miner, Jennifer A.; Phalke, Vaishali.

In: Journal of Bone and Joint Surgery - Series A, Vol. 89, No. 2, 02.2007, p. 358-366.

Research output: Contribution to journalArticle

Haig, Andrew J. ; Geisser, Michael E. ; Tong, Henry C. ; Yamakawa, Karen S J ; Quint, Douglas J. ; Hoff, Julian T. ; Chiodo, Anthony ; Miner, Jennifer A. ; Phalke, Vaishali. / Electromyographic and magnetic resonance imaging to predict lumbar stenosis, low-back pain, and no back symptoms. In: Journal of Bone and Joint Surgery - Series A. 2007 ; Vol. 89, No. 2. pp. 358-366.
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T1 - Electromyographic and magnetic resonance imaging to predict lumbar stenosis, low-back pain, and no back symptoms

AU - Haig, Andrew J.

AU - Geisser, Michael E.

AU - Tong, Henry C.

AU - Yamakawa, Karen S J

AU - Quint, Douglas J.

AU - Hoff, Julian T.

AU - Chiodo, Anthony

AU - Miner, Jennifer A.

AU - Phalke, Vaishali

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N2 - Background: Magnetic resonance imaging is commonly used to diagnose lumbar spinal stenosis. Some persons without symptoms have a small lumbar spinal canal. Electrodiagnosis has been used to diagnose spinal stenosis for over sixty years, but we are aware of no masked, controlled trials of the use of electrodiagnosis for that purpose. This study was performed to evaluate the relationships of magnetic resonance imaging measures and electrodiagnostic data with the clinical syndrome of spinal stenosis. Methods: One hundred and fifty persons between the ages of fifty-five and eighty years old, including asymptomatic volunteers and persons referred for lumbar magnetic resonance imaging, underwent clinical examination, electrodiagnosis, and magnetic resonance imaging. Subjects were excluded if they had neuromuscular disease, sacral cancer, or inadequate test results, which left 126 subjects for the final analysis. The final cohort was divided into three groups - no back pain, mechanical back pain, and clinical spinal stenosis - on the basis of the impression of the examining physician, for whom the results of the magnetic resonance imaging and electrodiagnostic testing were masked. A spine surgeon also reviewed both the imaging and clinical examination data. Results: The examining physician's diagnosis of clinical spinal stenosis was significantly related to the neurological findings on examination (p <0.05) and to the spine surgeon's diagnosis (p <0.001). The diagnosis of clinical spinal stenosis was also significantly related to the presence of fibrillations on electrodiagnostic testing (p ≤ 0.003), the minimum anteroposterior diameter of the spinal canal on the magnetic resonance images (p = 0.016), and the average of the two smallest spinal canal diameters (p = 0.008) on the images. Measurements on magnetic resonance imaging did not differentiate subjects with clinical spinal stenosis from controls better than chance, whereas paraspinal mapping electrodiagnosis scores did. Conclusions: This prospective, controlled, masked study of electrodiagnosis and magnetic resonance imaging for older subjects showed that imaging does not differentiate symptomatic from asymptomatic persons, whereas electrodiagnosis does. We believe that radiographic findings alone are insufficient to justify treatment for spinal stenosis. Level of Evidence: Diagnostic Level IV. See Instructions to Authors for a complete description of levels of evidence.

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