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Chiropractic Research Review

Electromyography More Accurate Than MRI at Predicting Spinal Stenosis

Developed in the first half of the 20th century, electromyography and other electrodiagnostic testing procedures are considered invaluable in the diagnosis of a mélange of neuromuscular disorders.

Electromyography is considered useful in the diagnosis of spinal stenosis because it not only tests the physiologic outcomes of the condition, it can also detect other disorders which either do not have obvious anatomical findings, or are not included in the field of examination under usual lumbar imaging tests. Despite its apparent usefulness, many reviews have not included electromyography as a diagnostic tool, due apparently to the paucity of research regarding its use on any particular disorder. As a result, the diagnosis of spinal stenosis continues to rely more on an individual practitioner's experience and judgment rather than any one diagnostic test.

In this prospective, double-controlled trial, scientists recruited 150 patients (30 asymptomatic volunteers, 30 people with low back pain but no MRI evidence of spinal stenosis, and 90 people with varying degrees of spinal stenosis) to participate in a series of physical and diagnostic examinations, including magnetic resonance imaging and electromyography. Findings were reviewed by a physiatrist, a neurosurgeon and a neuroradiologist to establish a "gold standard" patient population in whom there was complete agreement regarding whether the subject had spinal stenosis, low back pain, or was asymptomatic.

Unanimous agreement was reached on 55 patients. However, a quality check on electrodiagnostic data in this group identified seven patients with a neuromuscular disorder pathophysiologically different from spinal stenosis that had not been discovered by MRI or clinical examination, leading to the belief that electrodiagnostic testing could be useful in "preventing unnecessary intervention and detecting treatable alternative or complimentary diagnoses."

Conclusion: "Electrodiagnostic testing is quite specific and somewhat sensitive in diagnosing spinal stenosis in comparison with low back pain or asymptomatic persons. In addition, electrodiagnostic testing can detect neuromuscular diseases that mimics stenosis and impact treatment yet are not found on clinical evaluation. This first stringent proof of the utility of electrodiagnostic testing will open the door to more appropriate use of electrodiagnostic consultation for spinal disorders."

Haig AJ, Tong HC, Yamakawa KSJ, et al. The sensitivity and specificity of electrodiagnostic testing for the clinical syndrome of lumbar spinal stenosis. Spine 2004;30(23):2667-2676.

Chiropractic Research Review

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