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Diagnostic accuracy of multifidus muscle spontaneous activity by needle electromyography for the detection of lumbar foraminal and lateral exit-zone stenosis

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Abstract

Purpose

The medial branch of the posterior ramus of the lumbar spinal nerve is well known to be innervated independently and to end in the multifidus muscle without anastomosis. This prospective cohort study aimed to determine the diagnostic specificity and sensitivity of multifidus muscle denervation (MMD) by needle electromyography (N-EMG) for lumbar foraminal and lateral exit-zone stenosis (LF/LEZS).

Methods

We enrolled 61 consecutive patients experiencing unilateral dysesthesia and/or leg pain in the L4 or L5 regions with suspicious LF/LEZS. The Japanese Orthopedic Association (JOA) score, Visual Analog Scale (VAS) for leg pain, and N-EMG were examined. In this study protocol, all patients received at least 3 months of conservative therapy. Surgery was performed on patients who experienced less than 50 % VAS pain relief compared with their initial score after confirming the responsible level by lumbar nerve root block. The specificity of N-EMG was the proportion of patients who improved with conservative therapies (non-surgery) after 3 months. The sensitivity of N-EMG was the proportion of patients who improved with surgical therapies (surgery) after more than 12 months.

Results

Twenty-three patients underwent surgery. The initial lower JOA, positive Kemp test and motor weakness were significantly higher in the surgery group. The MMD by N-EMG indicated that 34 of 38 patients were negative in the non-surgery group. In the surgery group, 21 of 23 patients were positive. The diagnostic sensitivity and specificity were 91.3 and 92.1 %, respectively.

Conclusions

Needle electromyography is a simple and available additional method for the diagnosis of LF/LEZS.

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Acknowledgments

The authors wish to thank the following special technicians for their assistance with the study: Aichi Medical University (Mrs. Taeko Kamiya, Mrs. Yuka Shibata, Mr. Hiroshi Moriya). This work was partially supported by the Grant. Research Funding; AO Spine Japan. Consultant; none. Royalty/IP Payments; none. Other compensation; none. This research received the Grant from AO Spine Japan.

Conflict of interest

None.

Ethical standard

The study was approved by the institutional review board of the hospital. The IRB number was 11-052.

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Authors and Affiliations

  1. Department of Spine Center, Aichi Medical University, Karimata Yazako, Nagakute, Aichi, 480-1195, Japan

    Mikinobu Takeuchi, Norimitsu Wakao, Mitsuhiro Kamiya & Masakazu Takayasu

  2. Neurological Surgery, Aichi Medical University Hospital, Nagakute, Aichi, Japan

    Mikinobu Takeuchi, Koji Osuka, Aichi Niwa, Masahiro Aoyama, Reo Kawaguchi, Hiroshi Shima & Masakazu Takayasu

  3. Orthopedics Surgery, Aichi Medical University Hospital, Nagakute, Aichi, Japan

    Norimitsu Wakao, Mitsuhiro Kamiya & Atsuhiko Hirasawa

  4. Advanced Medical Research Center, Aichi Medical University Hospital, Nagakute, Aichi, Japan

    Masahiko Gosho

Authors
  1. Mikinobu Takeuchi
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  2. Norimitsu Wakao
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  3. Mitsuhiro Kamiya
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  4. Masahiko Gosho
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  6. Atsuhiko Hirasawa
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  7. Aichi Niwa
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  8. Masahiro Aoyama
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  9. Reo Kawaguchi
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  10. Hiroshi Shima
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  11. Masakazu Takayasu
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Correspondence to Mikinobu Takeuchi.

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Takeuchi, M., Wakao, N., Kamiya, M. et al. Diagnostic accuracy of multifidus muscle spontaneous activity by needle electromyography for the detection of lumbar foraminal and lateral exit-zone stenosis. Eur Spine J 24, 2281–2287 (2015). https://doi.org/10.1007/s00586-015-3846-9

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  • DOI: https://doi.org/10.1007/s00586-015-3846-9

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