Diagnosis Of Cervical Radiculopathy Research Articles

A review of electromyography techniques of the cervical paraspinal muscles.

Electrodiagnosis for cervical radiculopathy often involves exploration of the cervical paraspinal muscles. Accurate and reproducible results require a technique with specific anatomic localization, direction of insertion, extent of insertion, scoring system for insertion, and criteria for determining abnormality. We sought to understand if a published technique met these criteria. A Medline search found 39 articles with original research and 10 review articles involving the cervical paraspinals. A library search found 19 textbooks since 2000, but 9 were not available. Only two studies were specific to the question. Neither had reproducible techniques and they contradicted each other. Studies in which the paraspinals were used for comparison or inclusion did not provide any specific technique. The review articles and textbooks typically met none of our criteria and the few that discussed technique at all provided no reproducible methods. Despite 80 years of electrodiagnostic testing, there is no useful, reproducible technique for exploring the cervical paraspinal muscles. Yet such a paraspinal mapping technique has proven invaluable in the lumbar region. For cervical electromyography to be of value, the next step is to understand the anatomy and propose a reproducible technique. Subsequent research will determine whether the neck muscles are helpful in the diagnosis of cervical radiculopathy. The absence of a valid reproducible cervical paraspinal technique impedes clinical and scientific understanding of cervical radiculopathy.

Diagnostic accuracy of upper limb neurodynamic tests in the diagnosis of cervical radiculopathy

BackgroundUpper limb neurodynamic tests (ULNT) are used to diagnose neuropathic conditions such as cervical radiculopathy (CR). Within the literature, a positive ULNT is defined in markedly variable ways, which is likely why the diagnostic accuracy of these tests lacks consistency across studies. ObjectivesTo determine the diagnostic accuracy of single and combined upper limb neurodynamic tests ((ULNT)1,2a, 2b and 3) for cervical radiculopathy using test findings that are similar to those used in practice. DesignDiagnostic accuracy study (prospective) design following the updated STARD 2015 reporting guideline. MethodFrom 109 consecutively enrolled individuals with suspected CR. Of the 85 participants included, 27 (31.7%) were diagnosed with CR (mean age, 43.9years; Neck Disability Index 38,16%). ULNTs test were performed by a blind examiner to a CR reference standard of clinical diagnosis and magnetic resonance imaging verification provided by a neurosurgeon. ResultsIn general, the single tests were better at ruling in CR versus ruling out. Of the single ULNT, the ULNT3 demonstrated the strongest post-test probability change with a positive finding (73.28%). Three of four test combinations demonstrated the highest clinical utility for changing the post-test probability with a positive finding at 83.29% and with LR+ = 12.89 (95%CI: 3.10–53.62). Having none of the test's positive was able to rule out CR with LR- = 0.08 (95%CI: 0.01–0.56). ConclusionULNTs fail to significantly alter post-test probability when used singularly for diagnosis of CR. However, combinations of ULNT (3 out of 4 positive) can rule in CR, and rule out CR when all ULNT are negative.

Cervical Intraspinal Conduction Time by Magnetic Root Stimulation versus Conventional Electromyography in the Diagnosis of Cervical Radiculopathy

Background: Cervical radiculopathy (CR) is a pathological procedure that encompasses root of the cervical nerve. Cervical disc herniation, accompanied by cervical spondylosis, is among the most common causes of radiculopathy. Clinical neurophysiology is a medical field focused mainly on assessing activity in the nervous system and muscles being an expansion of neurological assessment, using particular same anatomical localization criteria as clinical testing. Objective: To evaluate the sensitivity and specificity of conduction time of the intraspinal segment of peripheral motor neurons in the diagnosis of CR using cervical root magnetic stimulation and conventional electromyography (EMG) study. Methods: Fifty patients (15 males and 35 females) aged 46.02±9.76 years with reported CR were subjected to an electrophysiological examination and control group consisted of 50 (36 females and 14 males) healthy volunteers aged 36.24±12.09 years. Analysis of sensory and motor nerve conduction, conventional needle EMG test, and motor evoked potentials (MEPs) for all (recording abductor pollicis brevis (APB), abductor digiti minimi (ADM), biceps brachii (BB), deltoid muscles) was conducted to determine the peripheral nerves, muscles, sensory and motor pathways. The motor evoked potential (MEP) parameters studied for the median, ulnar musculocutaneous and axillary nerves include latency of the spinal root {peripheral motor conduction time} (PMCT). Results: During direct cervical root stimulation, the PMCT of the median nerve shows the highest specificity (59%) than that of the ulnar nerve (57%), while the intraspinal latency shows the same specificity for both nerves (57%). In comparison, PMCT by kimura formula recording ADM during direct stimulation of the cervical root have the highest sensitivity (56%) than that of PMCT by kimura formula recording APB. Additionally, the recording of direct cervical root stimulation amplitude after deltoid muscle showed the highest specificity and sensitivity (57.0%, 58.0% respectively). On the other hand, PMCT shows the highest specificity and sensitivity while the BB muscle is recoded (62.0%, 49.0%). Conclusion: Overall, the current motor evoked potential study shows abnormalities in less than 60% of patients with cervical radiculopathy relative to conventional EMG needle study abnormalities that reached 90%. The intraspinal latency of the median and ulnar show low sensitivity and specificity. Keywords: Cervical radiculopathy, electromyography, motor evoked potentials Citation: Abdulhameed AK, Kaddori HG. Cervical intraspinal conduction time by magnetic root stimulation versus conventional electromyography in the diagnosis of cervical radiculopathy. Iraqi JMS. 2021; 19(1): 60-71. doi: 10.22578/IJMS.19.1.9

171. Postoperative recovery of motor strength and patient-reported physical function following anterior cervical discectomy and fusion

BACKGROUND CONTEXT While anterior cervical discectomy and fusion (ACDF) reportedly decreases neurological deficits, pain frequency and pain intensity, the functional outcomes are less clearly elucidated in the spine literature. Though consistent improvements from baseline in upper extremity strength have been noted following ACDF, the timeline of these improvements needs further evaluation. This study identifies the motor strength recovery timeline and further elaborates on the association between clinically-appreciable motor and patient-reported physical function recovery following ACDF. METHODS Patients undergoing elective, primary ACDF were identified from a single academic institution between 01/01/2013 – 09/01/2018. PROMIS computer adaptive test (CAT) data was prospectively obtained and retrospectively analyzed. Inclusion criteria included ages >18 years-old, clinical diagnosis of cervical radiculopathy and/or myelopathy confirmed on radiographic imaging, the ability to read/write English and provide informed consent. Exclusion criteria included revision surgery, combined anterior/posterior surgery, tumor, trauma, or infectious diagnoses. All surgeries were performed by one of three fellowship-trained spine surgeons. Demographic and surgical data, including the degree of motor weakness, were obtained from the hospital chart. In order to grade the degree of weakness, points were given for each strength deficit (eg, +1 points for each 4/5 muscle group). The minor preoperative weakness group was defined as total strength deficit RESULTS A total of 107 patients were identified. Baseline PROMIS physical function (PF) T-scores showed a statistically significant difference based on level of preoperative motor weakness (p=0.01). O patients with minor preoperative weakness, 62.5% achieved full strength recovery 1.5 months postoperatively compared to 38.5% of those with major preoperative weakness. PF T-scores increased throughout the postoperative period regardless of the level of preoperative weakness. However, the timeline of these gains in physical functioning differed. The majority of physical function recovery for minor weakness patients occurred in the first 1.5 months postoperatively while the physical function recovery for major weakness patients occurred over the course of 3 months postoperatively. CONCLUSIONS Our results indicate that the severity of the preoperative motor weakness influences the rate and degree of recovery. We highlight important features of both postoperative motor and patient-reported physical function recovery. While both weakness groups improved with treatment, patients with major preoperative motor weakness demonstrated longer time for recovery, poorer improvement to full strength, and worse functional results. Spine providers may use these results to better counsel ACDF patients on the general milestones of strength and functional recovery in the postoperative period. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

РОЛЬ УЛЬТРАЗВУКОВОГО ИССЛЕДОВАНИЯ В КОМПЛЕКСНОЙ ДИАГНОСТИКЕ ШЕЙНОЙ РАДИКУЛОПАТИИ (ОБЗОР ЛИТЕРАТУРЫ)

Изучено современное состояние вопроса диагностики шейной радикулопатии – широко распространенного заболевания, имеющего тенденцию к хронизации, потере трудоспособности и инвалидизации. Традиционные методы лучевой визуализации шейного отдела позвоночника – рентгенография, рентгеновская компьютерная и магнитно-резонансная томография – наряду с достоинствами имеют ряд недостатков: рентгенологическая визуализация не предоставляет информации о состоянии мягких тканей и связана с лучевой нагрузкой, доступность магнитно-резонансной томографии ограничена, что делает актуальной проблему поиска альтернативных методов диагностики.Достоинством ультразвукового исследования является доступность, быстрота, полипозиционность, отсутствие лучевой нагрузки, возможность многократного выполнения. Однако в диагностике шейной радикулопатии его возможности еще не до конца раскрыты, в научной литературе имеются лишь единичные упоминания о возможностях метода, а в повседневной клинической практике он в указанных целях не используется. Имеющиеся в литературе данные об исследовании других отделов позвоночника и периферических нервов, а также единичные сообщения об ультразвуковых исследованиях вертебральных и мягкотканных структур шейного отдела позволяют прогнозировать высокую эффективность ультразвуковой визуализации в диагностике шейной радикулопатии и перспективность дальнейших исследований данной проблемы.

Effects of Anxiety and Depressive Manifestations of Personality on Functional Recovery of Patients with Cervical Pain Syndrome

Introduction: Cervical syndrome is a set of symptoms that are manifested by pain in the neck segment and shoulder blade region, with the feeling of tightness and tension, and limited movement of the neck segment of the spine. Because of the long-term duration of symptoms, we often find psychopathological manifestations in the form of anxiety and depression in these patients.Objective: The goal was to detect the presence of anxiety and depressive manifestations of personality in patients with cervical syndrome at the beginning of rehabilitation treatment, to determine to what extent the presence of anxiety and depressive symptomatology affects the functional recovery of patients after a physical rehabilitation treatment.Patients and Methods: The study was conducted as a prospective study involving 100 patients. Criteria for inclusion were the diagnosis of cervical syndrome and the age of patients between 20 and 60 years of age. Exclusion criteria were diagnosis of cervical radiculopathy, vertebrobasilar syndrome, diagnosis of anxiety and depressionconfirmed by psychiatrist, as well as use of psychotropic substances. On admission, each patient filled in Beck’s questionaire for anxiety and depression (BAI and BDI)and accordingly patients were divided into 3 groups.Results: Out of total of 100 patients, 74% were female and 26% were male. In 77% of patients psychopathological manifestations of personality were found. A statistically significant association of gender and group placement was found (p=0,003). The women had a far greater percentage of anxiety and anxiety-depressive manifestations of the personality than men. In terms of BAI and BDI, there was a statistically significant difference between genders. All of the parameters ( VAS, Schober, CSS) monitored during rehabilitation treatment were improved at the end of treatment (p=0,0001). There was a positive correlation of BAI and BDI with CSS on admission and at discharge (p=0,05) in a group of anxiety-depressed patients.Conclusion: The presence of anxiety and depressive manifestations of personality did not have a negative impact on the functional recovery of patients. Physical therapy has led to reduction of pain, increased mobility and better functional status of cervical spine for patients with cervical spine syndrome.

S78. MRI assessment of neck muscles in patients with unilateral cervical radiculopathy patients

Introduction Several recent studies have investigated the changes of multifidus muscles in patients with chronic neck pain. Also, the longus coli muscle, one of the deep cervical flexor muscles, showed smaller cross sectional area (CSA) in patients with chronic neck pain in comparison with healthy people. To our knowledge, there is no study investigating the association between morphological features of cervical paravertebral muscles in electrodiagnosed cervical radiculopathy patients. In this study, we investigate the change in CSA and composition of the cervical flexor and multifidus muscles using the digital data from MRIs of patients with electrodiagnosed cervical radiculopathy. Methods Twenty-four patients with unilateral cervical radicular pain who had cervical MRI and EMG examinations between 1 January 2015 and 2016 were retrospectively analysed. The inclusion criteria were as follows: (1) patients with the symptoms of unilateral cervical pain or referral to one upper limb, (2) diagnosis of cervical radiculopathy in EMG. Exclusion criteria included: (1) a history of cervical surgery; (2) a history of spinal fracture or injuries; (3) primary or metastatic spinal tumor. Axial slice at the level of C4-5 mid disc level image was selected to calculate the muscle CSA, with their maximal CSAs. Total CSA and functional CSA measurements of the bilateral longus colli, sternocleidomastoid and multifidus muscles were measured by using Image J (version 1.43, National Institutes of Health, Bethesda, Maryland). All muscle measurements were acquired by one investigators. Functional CSA measurement was obtained by using threshold method (including only pixels within lean muscle tissue range). Statistical analysis was performed using SPSS® v. 15. Results The baseline characteristics of the study participants are shown in Table 1. There was no significant difference in total CSA in longus colli, sternocleidomastoid and multifidus muscles between involved and uninvolved groups. Data analysis showed significant difference between the functional CSA of the lognus colli muscle the involved/uninvolved sides (Table 2). Also, there is significant difference in the ratio of longus colli musle (functional longus colli muscle CSA/total longus colli muscle CSA) between the involved and uninvolved sides (P Conclusion This is the study to show via MRI assessment that patients with cervical radiculopathy have smaller ipsilateral functional CSA of the longus colli muscle LCM in comparison with uninvolved side. Consideration of these muscles in MRI could be helpful in the diagnosis and prognosis of cervical radiculopathy.

What is the Best Way to Apply the Spurling Test for Cervical Radiculopathy?

A diagnosis of cervical radiculopathy is based largely on clinical examination, including provocative testing. The most common maneuver was described in 1944 by Spurling and Scoville. Since then, several modifications of the original maneuver have been proposed to improve its value in the diagnosis of cervical radiculopathy. We assessed the ability of six known variations of the Spurling test to reproduce the complaints of patients diagnosed with cervical radiculopathy. We prospectively enrolled 67 patients presenting with cervical radicular-like symptoms and concordant radiographic findings. Each patient underwent six distinct provocative cervical spine maneuvers by two examiners, during which three parameters were recorded: (1) pain intensity (VAS score), (2) paresthesia intensity (0 - no paresthesia, 1 - mild to moderate, and 2 - severe), and (3) characteristic pain distribution (0 - no pain, 1 - neck pain only, 2 - arm pain only, 3 - pain elicited distal to the elbow). The interobserver reliability of the reported VAS score (measured by the intraclass coefficient correlation) ranged from 0.78 to 0.96 and the calculated kappa values of the categorical parameters ranged from 0.58 to 1.0 for paresthesia intensity and from 0.63 to 1.0 for pain distribution. Differences in scores elicited between the two examiners for the 67 patients were resolved by consensus. A maneuver consisting of extension, lateral bending, and axial compression resulted in the highest VAS score (mean, 7) and was associated with the most distally elicited pain on average (mean, 2.5). The highest paresthesia levels were reported after applying extension, rotation, and axial compression (mean, 1). These maneuvers, however, were the least tolerable, causing discontinuation of the examination on three occasions. Whenever cervical radiculopathy is suspected our observations suggest the staged provocative maneuvers that should be included in the physical evaluation are extension and lateral bending first, followed by the addition of axial compression in cases with an inconclusive effect.

Evidence-Based Approach to the Physical Therapy Diagnosis and Management of Neck and Upper Extremity Pain using Cervical and Thoracic Spine Thrust Manipulation: A Case Report

Neck and upper extremity pain are common medical diagnoses for patients seeking physical therapy care. The purpose of this case report is to describe an evidence-based approach to the physical therapy diagnosis and management of a 46-year-old female reporting insidious onset neck pain and bilateral upper extremity paraesthesiae of two years duration. Evaluation of examination data, based on research data with regard to diagnostic accuracy of the tests and measures used, indicated a diagnosis of cervical radiculopathy. Management was based on a treatment-based classification approach and focused on restoring mobility by way of thrust manipulations directed at the thoracic and cervical spine. At the completion of the physical therapy plan of care (8 visits), the patient rated her perceived improvement on the Global Rating of Change Scale as "a very great deal better." The Numerical Pain Rating Score improved from 6/10 to 0/10. Patient-perceived disability, as measured by the Neck Disability Index, improved from 26% to 0%, and the patient's score on the modified Oswestry Disability Index improved from 30% to 0%. Bilateral upper extremity paraesthesiae also had completely resolved. These clinically meaningful improvements in pain and perceived disability were maintained six weeks after discharge. While a cause-and-effect relationship cannot be inferred from a case report, it is plausible that an orthopaedic manual physical therapy approach in the management of patients with both neck and upper extremity pain may result in decreased pain and improved function. Further clinical trials are needed to test this hypothesis.

A comparison of magnetic resonance imaging and neurophysiological studies in the assessment of cervical radiculopathy

Neurophysiological studies (NPS) are often used by both neurosurgeons and neurologists to supplement neuroimaging findings in the diagnosis of cervical radiculopathy and in operative decision-making. The aim of this study was to assess whether nerve conduction and electromyographic studies added significant information to that obtained from high resolution MRI to warrant routine use. Over the 10-year period (1991-2001), we identified 48 patients who underwent both preoperative NPS and MRI for cervical radiculopathy. Sensitivity of MRI and NPS for diagnosing cervical radiculopathy was 93 and 42%, respectively. Whilst the positive predictive values for MRI and NPS were similar (91% versus 86%), the former had a higher negative predictive value (25% versus 7%). In only one case was the decision to operate based on NPS despite a negative MRI. We therefore suggest that in patients with clinical and MRI evidence of cervical radiculopathy, NPS has limited additional diagnostic value.

Two-dimensional MRI at 1.5 and 0.5 T versus CT myelography in the diagnosis of cervical radiculopathy

A prospective comparison was made of standard two-dimensional MRI sequences, at both high and midfield strength, with CT myelography in 23 patients with cervical spondylosis. MRI is adequate for assessment of cord compression, where high field strength is superior to midfield strength. MRI using 4-mm sections is inadequate for presurgical assessment of root compression. It remains to be proven whether thin-section white-CSF volume sequences or gadolinium-enhanced volume studies can replace CT myelography.

Two-dimensional MRI at 1.5 and 0.5 T versus CT myelography in the diagnosis of cervical radiculopathy

Two-dimensional MRI at 1.5 and 0.5 T versus CT myelography in the diagnosis of cervical radiculopathy

A comparison of thermography and electromyography in the diagnosis of cervical radiculopathy

We studied 20 asymptomatic control subjects and 14 patients with clinically unequivocal cervical radiculopathy to compare the diagnostic value of thermography with that of electromyography. We measured the average skin temperature of designated regions over the neck, shoulder, and upper extremities. We then compared the temperature between corresponding regions of the two limbs, and between fingers innervated by different roots in the same hand. Thermography was abnormal in 6 patients (43%), whereas electromyography was abnormal in 10 (71%). Thermographic abnormalities were seen only in the hands and fingers, and the pattern did not follow the dermatome of the clinically involved cervical root. When compared to electromyography, thermography provided no additional diagnostic information. Thus, thermography does not have an established role in the evaluation of patients with cervical radiculopathy.