P334 Value of electrophysiological studies in detecting lumbo-sacral radiculopathy in patients with questionable MRI findings

• Published in: Clinical neurophysiology Vol. 128; no. 9; p. e286
• Main Authors: Raafat, Heba, Mahdy, Wael El, Raafat, Waleed, Falaky, Omar El
• Format: Journal Article
• Language: English
• Published: Elsevier B.V 01-09-2017
• Subjects: Electrophysiological studies; Lumbo-sacral MRI Lumbo-sacral radiculopathy; Electrophysiological studies; Lumbo-sacral MRI Lumbo-sacral radiculopathy
• ISSN: 1388-2457; 1872-8952
• DOI: 10.1016/j.clinph.2017.07.342

To test value of electrophysiologic studies in confirming lumbo-sacral radiculopathies in patients with questionable MRI findings for nerve root compression.
The study was conducted on 80 adult patients with sciatica, weakness of myotomal distribution in one limb, hypoesthesia in dermatomal distribution, all with MRI findings of focal disc protrusion/bulge with questionable nerve root compromise not correlating with the clinical symptoms.
25% of cases were acute, 60% subacute, and 15% were chronic. Clinical picture was sciatica with +ve SLRT in 35% of cases, L5 myotomal weakness in 30% of cases, S1 myotomal weakness 15% of cases, L5/S1 myotomal weakness in 15% of cases, sensory deficit in 4% of cases, back pain in 1.25% of cases. Positive EMG findings were found in 96.3% of cases, 96.3% had +ve lower limb findings, 57.5% had +ve paraspinal muscles findings, 70% had small CMAP amplitude, and 7.5% had active denervating potentials. 44% of cases were treated conservatively, while 56% of cases underwent surgery. There was a statistically significant association between the EMG results and clinical picture of radiculopathy, while there was no statistical significance between the MRI findings and the clinical picture of radiculopathy.
Electrophysiological studies are efficacious in diagnosing and predicting prognosis of lumbo-sacral radiculopathies.
The proper management decision should be based on the triad of imaging, electrophysiological tests and clinical context.
MRI accuracy in detecting nerve root compromise is questionable by conflicting reports including this study.