Findings of Electrodiagnostic Studies in Moderate to Severe Lumbar Central Spinal Stenosis—Electrodiagnostic Studies in Lumbar Central Spinal Stenosis

Min Cheol Chang,Donghwi Park

doi:10.3390/healthcare9020164

Abstract

Purpose: The purpose of this study was to investigate the findings of electrodiagnostic studies (nerve conduction study (NCS) and electromyography (EMG)) in patients with moderate and severe lumbar central spinal stenosis (LCSS). Methods: We retrospectively reviewed the medical records of Ulsan University Hospital and identified 32 consecutive patients (mean age = 66.9 ± 7.4 years; male:female = 8:24) with LCSS. Based on the results of T2 axial magnetic resonance imaging at the level of L4–5, patients were categorized as having severe (n = 14) or moderate LCSS (n = 18). Results from NCS and EMG were retrieved. Additionally, we included 15 age- and sex-matched volunteers without LCSS (mean age = 65.2 ± 8.0 years; male:female = 4:11) to serve as a control group. Results of NCS and EMG were compared between the three groups. Results: We found that, compared to normal subjects, patients with moderate or severe LCSS presented significantly lower distal amplitudes of the compound motor action potential of both peroneal and tibial nerves. Regarding EMG, positive sharp waves and fibrillation potentials were exclusively observed in patients with severe LCSS group (28.6%). Conclusion: Electrodiagnostic studies were significantly altered in patients with moderate and severe LCSS. Our results may be helpful to diagnose LCSS-induced radiculopathy and to differentiate it from other causes of peripheral nerve pathologies.

Highlights

Lumbar central spinal stenosis (LCSS) is defined as the narrowing of the lumbar spinal canal due to bulging intervertebral discs and/or hypertrophy of the ligamentum flavum and facet joints that results in the compression of nerve roots [1]
Patients were considered for analysis if they met all of the following criteria: (1) pain attributable to lumbar central spinal stenosis (LCSS), characterized by buttock and/or lower extremity pain that appeared during walking or prolonged standing and was relieved by leaning forward or sitting; (2) moderate or severe LCSS diagnosed on axial MRI, as explained below; (3) age between
Regarding nerve conduction study (NCS), while distal amplitudes in both the peroneal and tibial nerves were significantly smaller in the severe and moderate LCSS groups compared to the normal group, no significant difference was observed within the LCSS groups in this regard

Summary

Introduction

Published: 3 February 2021Lumbar central spinal stenosis (LCSS) is defined as the narrowing of the lumbar spinal canal due to bulging intervertebral discs and/or hypertrophy of the ligamentum flavum and facet joints that results in the compression of nerve roots [1]. The most characteristic symptom of LCSS is neurogenic claudication, which refers to leg pain, fatigue, heaviness, and/or weakness that typically worsens with lumbar extension [5]. The diagnosis of LCSS relies on a combination of symptoms, physical findings, and imaging study results (most commonly magnetic resonance imaging (MRI). Computed tomography (CT) [5,6] Electrodiagnostic studies such as nerve conduction study (NCS) and electromyography (EMG) are often used to identify the specific site to be treated when equivocal findings and/or multiple-level lesions are detected via CT or MRI [5]. The typical electrophysiological finding in LCSS is radiculopathy, which results from nerve root damage by mechanical compression or ischemic injury [7,8].

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