Correlation of Electrodiagnostic and Clinical Findings in Unilateral S1 Radiculopathy

  • Seyed Mansoor Rayegani Department of Physical Medicine and Rehabilitation, Physical Medicine and Rehabilitation Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran. AND Shohada Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
  • Seyed Ahmad Raeissadat Department of Physical Medicine and Rehabilitation, Physical Medicine and Rehabilitation Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran. AND Clinical Development Research Center, Shahid Modarres Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
  • Elham Loni Department of Physical Medicine and Rehabilitation, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran.
  • Navid Rahimi Department of Physical Medicine and Rehabilitation, Physical Medicine and Rehabilitation Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran. AND Shohada Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
  • Shahram Rahimi-Dehgolan Department of Physical Medicine and Rehabilitation, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
  • Leyla Sedighipour Department of Physical Medicine and Rehabilitation, Physical Medicine and Rehabilitation Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran. AND Shohada Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Keywords: Consistency, EMG-NCS, H reflex, Lumbosacral, MRI, S1 radiculopathy

Abstract

Lumbosacral radiculopathy is a challenging diagnosis, and Electrodiagnostic study (EDX) is a good complementary test for Magnetic Resonance Imaging (MRI). Physical examination, MRI and electrodiagnosis have different diagnostic values in this regard. MRI can provide anatomical evidence and is useful in choosing a treatment process, but it could also have false positive results. In this study, we assessed the correlation of clinical and electrodiagnostic findings in patients with positive MRI findings for S1 radiculopathy. EDX was performed for 87 patients referred with clinical and MRI diagnosis of S1 radiculopathy. The consistency between EDX results, MRI, and clinical findings were evaluated by Pearson chi 2 and odds ratio. Fifty-eight percent of patients had disc protrusion, and 42% had extrusion. Physical examination revealed absent Achilles reflex in 83% and decreased S1 dermatome sensation in 65%. In this study, EDX sensitivity was about 92%. The highest consistency among EDX parameters and physical examination findings was between absent H-reflex and decreased Achilles reflex (OR=6.20, P=0.014), but there was no significant consistency between H-reflex and neither muscular weakness nor SLR test result (P>0.05). There was also no relationship between type of disc herniation in MRI and H reflex. There was correlation between H-reflex abnormalities and absent ankle reflex in patients with unilateral L5-S1 disc herniation in MRI. Results of this study showed that in patients with positive MRI for L5-S1 disc protrusion and S1 nerve root compression, it is still beneficial to perform EDX for selected patients.

References

Velázquez-Pérez L, Sánchez-Cruz G, Pérez-González RM.Neurophysiological diagnosis of lumbosacral radicular compression syndrome from late responses.Rev Neurol 2002;34:819-823.

Lauder TD, Dillingham TR, Andary M, et al. Effect of history and exam in predicting electrodiagnostic outcome among patients with suspected lumbosacral radiculopathy. Am J Phys Med Rehabil.2000;79:60-68.

Barr K. Electrodiagnosis of lumbar radiculopathy. Phys Med RehabilClin N Am. 2013;24:79-91.

Tong HC. Specificity of needle electromyography for lumbar radiculopathy in 55- to 79-yr-old subjects with low back pain and sciatica without stenosis. Am J Phys Med Rehabil. 2011 Mar;90(3):233-8; quiz 239-42. doi: 10.1097/PHM.0b013e31820b163b.

Hasankhani EG, Omidi-Kashani F. Magnetic Resonance Imaging versus Electrophysiologic Tests in Clinical Diagnosis of Lower Extremity Radicular Pain. ISRN neuroscience 2013;4:4 doi:10.1155/2013/952570. Available at http://downloads.hindawi.com/journals/isrn.neuroscience/2013/952570.pdf.Accessed: December 12, 2015.

Coster S, De Bruijn S. Tavy D. Diagnostic value of history, physical examination and needle electromyography in diagnosing lumbosacral radiculopathy. J Neurol. 2010;257:332-337.

Dillingham TR, Lauder TD, Andary M, et al. Identifying lumbosacral radiculopathies: an optimal electromyographicscreen.Am J Phys Med Rehabil.2000;79:496-503.

Charles Cho S, Ferrante MA, Levin KH, Harmon RL, So YT. Utility of electrodiagnostic testing in evaluating patients with lumbosacral radiculopathy: An evidence-based review. Muscle Nerve. 2010;42:276-282.

Maus T.Imaging the back pain patient.Phys Med RehabilClin N Am. 2010;21:725-766.

Makovec M, Benedicic M, Bosnjak R. Hwave and spinal root potentials in neuromonitoring of S1 root function during evacuation of herniated disc:preliminary results. Croat Med J. 2006;47:298-304.

Bobinac-Georgijevski A, Sokolovic-Matejcic B, Graberski M. The H or F wave latencies in medial gastrocnemius in the electrodiagnostic study of sciatica patients with suspected S1 radiculopathy. Neurol Croat. 1991;40:85-91.

Braune HJ, Wunderlich MT. Diagnostic value and different neurophysiological methods in the assessment of lumbar nerve root lesions. Arch Phys Med Rehabil. 1997;78:518-520.

Tarulli AW, Raynor EM. Lumbosacral radiculopathy.Neurol clinic.2007;25:387-390.

Dumitru D, Zwarts M. Focal peripheral neuropathies. In: Dumitru D,Amato A, Zwarts M, eds. Electrodiagnostic Medicine.4th edition. Philadelphia,PA: Hanley and BelfusInc; 2002, 1043-1126.

Sandoval AE. Electrodiagnostics for low back pain.Phys Med RehabilClin N Am. 2010;2:767-776.

Mondelli M, Aretini A, Arrigucci U, Ginanneschi F, Greco G, Sicurelli F. Clinical findings and electrodiagnostic testing in 108 consecutive cases of lumbosacral radiculopathy due to herniated disc.NeurophysiolClin. 2013;43:205-215.

Published
2019-07-13
How to Cite
1.
Rayegani SM, Raeissadat SA, Loni E, Rahimi N, Rahimi-Dehgolan S, Sedighipour L. Correlation of Electrodiagnostic and Clinical Findings in Unilateral S1 Radiculopathy. Acta Med Iran. 57(4).
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Articles