Evaluating Lumbar Radiculopathy
James B. Talmage
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Marjorie Eskay-Auerbach
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J. Edward Blaisdell
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Abstract

For workers’ compensation, most requests for a permanent impairment rating of low back injuries involve the diagnostic labels of nonspecific chronic low back pain or intervertebral disk herniation. Use of the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), Sixth Edition, to choose the right diagnosis and class for these injuries is the first step and involves correctly choosing between “nonverifiable radicular complaints” and “residual radiculopathy.” Evaluators must be able to distinguish persisting radiculopathy, as defined in the sixth edition, from resolved radiculopathy and from nonverifiable radicular complaints and to support findings with objective clinical evidence. Clinical evidence of chronic radiculopathy might include motor weakness, muscle atrophy, impaired sharp–dull discrimination, and/or abnormal electrodiagnostic tests, provided the findings are persistent and there are reflex abnormalities. When considering radiculopathy in the appropriate spine grid of the AMA Guides, Sixth Edition, the evaluator must distinguish radicular (limb) symptoms that are continuous, intermittent, or completely resolved. Positive electromyography (EMG) studies for acute radiculopathy are a sufficient objective finding to state the person has radiculopathy on the date of the test; individuals with positive needle EMG do have persisting radiculopathy at maximum medical improvement, but this does not mean that radiculopathy must persist despite time and treatment.

  • 1.

    Suri P, Rainville J, Katz JN, et al. The accuracy of the physical examination for the diagnosis of midlumbar and low lumbar nerve root impingement. Spine. 2011;36(1):6373.

    • Search Google Scholar
    • Export Citation
  • 2.

    Hancock MJ, Koes, B, Ostelo R, Peul W. Diagnostic accuracy of the clinical examination in identifying the level of herniation in patients with sciatica. Spine. 2011:36(11); E712E719.

    • Search Google Scholar
    • Export Citation
  • 3.

    Nezari NH, Schneiders AG, Hendrick PA. Neurological examination of the peripheral nervous system to diagnose lumbar spinal disc herniation with suspected radiculopathy: a systematic review and meta-analysis. Spine. 2013; 13(6):657674.

    • Search Google Scholar
    • Export Citation
  • 4.

    Cho SC, Ferrante MA, Levin KH, et al. Utility of electrodiagnostic testing in evaluating patients with lumbosacral radiculopathy: an evidence based review (AANEM Practice Guideline). Muscle Nerve. 2010; 42:276282.

    • Search Google Scholar
    • Export Citation
  • 5.

    Taylor CS, Coxon AJ, Watson PC, Greenough CG. Do L5 and S1 nerve root compressions produce radicular pain in a dermatomal pattern? Spine. 2013; 38(12):995998.

    • Search Google Scholar
    • Export Citation
  • 6.

    Jeon CH, Chung NS, Lee Y, Son K, Kim J. Patients with foot drop: A Simple and Useful Test to Differentiate Lumbar Radiculopathy and Peroneal Neuropathy. Spine. 2013; 38(3):257263.

    • Search Google Scholar
    • Export Citation
  • 7.

    American Academy of Neurology Therapeutics and Technology Assessment Subcommittee. Assessment: dermatomal somatosensory evoked potentials. Neurology. 1997; 49:11271130.

    • Search Google Scholar
    • Export Citation
  • 8.

    Aminoff MJ. The clinical role of somatosensory evoked potential studies: a critical appraisal. Muscle Nerve. 1984; 7:345354.

  • 9.

    Aminoff MJ, Goodin DS, Barbaro NM, Weinstein PR, Rosenblum ML. Dermatomal somatosensory evoked potentials in unilateral lumbosacral radiculopathy. Ann Neurol. 1985; 17:171176.

    • Search Google Scholar
    • Export Citation
  • 10.

    Banerjee TK, Mostofi MS, Weerasinghe V, Sedgwick EM. Magnetic stimulation in the determination of lumbosacral motor radiculopathy. Electroenceph Clin Neurophys. 1993; 89:221226.

    • Search Google Scholar
    • Export Citation
  • 11.

    Bischoff C, Meyer BU, Machetanz J, Conrad B. Value of magnetic stimulation in the diagnosis of radiculopathies. Muscle Nerve. 1993;16:154161.

    • Search Google Scholar
    • Export Citation
  • 12.

    Bodner RA, Levin KH, Wilbourn AJ. Lumbosacral radiculopathy: comparison of surgical and EMG localization (abstract). Muscle Nerve. 1995;18:1071.

    • Search Google Scholar
    • Export Citation
  • 13.

    Chang CW, Shieh SF, Li CM, et al. Measurement of motor NCV of the sciatic nerve in patients with piriformis syndrome: a magnetic stimulation study. Arch Phys Med Rehabil. 2006; 87:13711375.

    • Search Google Scholar
    • Export Citation
  • 14.

    Chiodo A, Haig AJ, Yamakawa KSJ, et al. MRI v. electrodiagnostic root compromise in lumbar spinal stenosis. Am J Phys Med Rehabil. 2008; 87:789797.

    • Search Google Scholar
    • Export Citation
  • 15.

    Cho SC, Ferrante MA, Levin KH, et al. Utility of electrodiagnostic testing in evaluating patients with lumbosacral radiculopathy: evidence based review. Muscle Nerve. 2010; 42:276282.

    • Search Google Scholar
    • Export Citation
  • 16.

    Czyrny JJ, Lawrence J. Importance of paraspinal muscle electromyography in cervical and lumbosacral radiculopathies. Am J Phys Med Rehabil. 1995; 74:458459.

    • Search Google Scholar
    • Export Citation
  • 17.

    Date ES, Mar EY, Bugola MR, Teraoka JK. Prevalence of lumbar paraspinal spontaneous activity in asymptomatic subjects. Muscle Nerve. 1996; 19:350354.

    • Search Google Scholar
    • Export Citation
  • 18.

    Dillingham TR, Pezzin LE, Lauder TD. Relationship between muscle abnormalities and symptom duration in lumbosacral radiculopathies. Am J Phys Med Rehabil. 1998; 77:103107.

    • Search Google Scholar
    • Export Citation
  • 19.

    Dillingham TR, Pezzin LE, Lauder TD, et al. Symptom duration and spontaneous activity in lumbosacral radiculopathy. Am J Phys Med Rehabil. 2000; 79:124132.

    • Search Google Scholar
    • Export Citation
  • 20.

    Dillingham TR, Lauder TD, Andary M, et al. Identifying lumbosacral radiculopathies: an optimal electromyographic screen. Am J Phys Med Rehabil. 2000; 79:496503.

    • Search Google Scholar
    • Export Citation
  • 21.

    Dumitru D, Dreyfuss P. Dermatomal/segmental somatosensory evoked potential evaluation of L5/S1 unilateral/unilevel radiculopathies. Muscle Nerve. 1996; 19:442449.

    • Search Google Scholar
    • Export Citation
  • 22.

    Dumitru D, Diaz CA, King JC. Prevalence of denervation in paraspinal and foot intrinsic musculature. Am J Phys Med Rehabil. 2001; 80:482490.

    • Search Google Scholar
    • Export Citation
  • 23.

    Eisen A. The somatosensory evoked potential. Can J Neurol Sci. 1982; 9:6577.

  • 24.

    Eisen A. Electrodiagnosis of radiculopathies. Neurol Clinics. 1985; 3:495510.

  • 25.

    Ertekin C, Nejat R, Sirin H, et al. Comparison of magnetic coil and needle electrical stimulation in diagnosis of lumbosacral radiculopathy. Muscle Nerve. 1994;17:685686.

    • Search Google Scholar
    • Export Citation
  • 26.

    Evans BA, Stevens JC, Dyck PJ. Lumbosacral plexus neuropathy. Neurol. 1981; 31:132730.

  • 27.

    Fishman LM, Zybert PA. Electrophysiologic evidence of piriformis syndrome. Arch Phys Med Rehabil. 1992; 73:359364.

  • 28.

    Fishman LM, Dombi GW, Michaelsen C, et al. Piriformis syndrome: diagnosis, treatment, and outcome: a ten-year study. Arch Phys Med Rehabil. 2002; 83:295301.

    • Search Google Scholar
    • Export Citation
  • 29.

    Fisher MA. H reflexes and F waves: physiology and clinical indications. Muscle Nerve. 1992;15:12231233.

  • 30.

    Fisher MA, Rivner RH. Contemporary role of F-wave studies. Muscle Nerve. 1998;21:10981105.

  • 31.

    Gilliatt RW. Physical injury to peripheral nerves—physiologic and electrodiagnostic aspects. Mayo Clin Proc. 1981;56:361370.

  • 32.

    Haig AJ. Clinical experience with paraspinal mapping. I: Neurophysiology of the paraspinal muscles in various spinal disorders. Arch Phys Med Rehabil. 1997;78:11771184.

    • Search Google Scholar
    • Export Citation
  • 33.

    Haig AJ. Clinical experience with paraspinal mapping. II: A simplified technique that eliminates three fourths of needle insertions. Archives Phys Med Rehabil. 1997;78:11851190.

    • Search Google Scholar
    • Export Citation
  • 34.

    Haig AJ, Moffroid M, Henry S, et al. Technique for needle localization in paraspinal muscles with cadaveric confirmation. Muscle Nerve. 1991;14:521526.

    • Search Google Scholar
    • Export Citation
  • 35.

    Haig AJ, Talley C, Grobler LJ, LeBreck DB. Paraspinal mapping. Muscle Nerve. 1993;16:477484.

  • 36.

    Haig AJ, LeBreck DB, Powley SG. Paraspinal mapping: quantified needle EMG of the paraspinal muscles in persons without LBP. Spine. 1995; 20:715721.

    • Search Google Scholar
    • Export Citation
  • 37.

    Haig AJ, Tong HC, Yamakawa KSJ, et al. Sensitivity and specificity of electrodiagnostic testing for the clinical syndrome of lumbar spinal stenosis. Spine. 2005; 30:26672676.

    • Search Google Scholar
    • Export Citation
  • 38.

    Haig AJ, Yamakawa K, Hudson DM. Paraspinal EMG in high lumbar and thoracic lesions. Am J Phys Med Rehabil. 2000; 79:336342.

  • 39.

    Haldeman S, Shouka M, Robboy S. Computed tomography, electrodiagnostic and clinical findings in chronic Workers' Compensation patients with back and leg pain. Spine. 1988; 13:345350.

    • Search Google Scholar
    • Export Citation
  • 40.

    Khatri BO, Baruah J, McQuillen MP. Correlation of electromyography with computed tomography in evaluation of lower back pain. Arch Neurol. 1984; 41:594597.

    • Search Google Scholar
    • Export Citation
  • 41.

    Kieffer SA, Cacayorin ED, Sherry RG. The radiological diagnosis of herniated lumbar intervertebral disk–a current controversy. JAMA. 1984; 251:11921195.

    • Search Google Scholar
    • Export Citation
  • 42.

    Kim BJ, Date ES, Derby R, et al. Electromyographic technique for lumbar multifidus examination: comparison of previous techniques used to localize the multifidus. Arch Phys Med Rehabil. 2005;86:13251329.

    • Search Google Scholar
    • Export Citation
  • 43.

    Kothari MJ, Preston DC, Plotkin GM, et al. Electromyography. Do the diagnostic ends justify the means? Arch Phys Med Rehabil. 1995; 76:947949.

    • Search Google Scholar
    • Export Citation
  • 44.

    Lauder TD, Dillingham TR, Huston CW, et al. Lumbosacral radiculopathy screen: optimizing the number of muscles studies. Am J Phys Med Rehabil. 1994; 73:394402.

    • Search Google Scholar
    • Export Citation
  • 45.

    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; 79:6068.

    • Search Google Scholar
    • Export Citation
  • 46.

    Lee SJ, Han TR, Hyun JK, et al. EMG findings in nucleus polposus-induced radiculopathy in the rat. Spine. 2006;31:20532058.

  • 47.

    Levin KH. L5 radiculopathy with reduced superficial peroneal sensory responses: intraspinal and extraspinal causes. Muscle Nerve. 1998; 21:37.

    • Search Google Scholar
    • Export Citation
  • 48.

    Lewis AM, Layzer R, Engstrom JW, et al. MR neurography in extraspinal sciatica. Arch Neurol. 2006; 63:14691472.

  • 49.

    Linden D, Berlit P. Comparison of late responses, EMG studies, and motor evoked potentials in acute lumbosacral radiculopathies. Muscle Nerve. 1995; 18:12051207.

    • Search Google Scholar
    • Export Citation
  • 50.

    Marin R, Dillingham TR, Chang A, Belandres PV. EDB reflex in normals and patients with radiculopathies. Muscle Nerve. 1995; 18:5259.

  • 51.

    Matsui H, Kanamori M, Kawaguchi Y, et al. Clinical and electrophysiologic characteristics of compressed lumbar nerve roots. Spine. 1997;22:21002105.

    • Search Google Scholar
    • Export Citation
  • 52.

    Nardin RA, Patel MR, Gudas TF, et al. EMG and MRI in the evaluation of radiculopathy. Muscle Nerve. 1999; 22:151155.

  • 53.

    Nishida T, Kompoliti A, Janssen I, Levin K. H reflex in S1 radiculopathy. Muscle Nerve. 1996; 19:915917.

  • 54.

    Pape E, Eldevik OP. P1 latency interroot comparison enhances the validity of scalp recorded somatosensory evoked potentials to diagnose nerve root dysfunction in sciatica. Spine. 1997; 22:298807.

    • Search Google Scholar
    • Export Citation
  • 55.

    Pease WS, Kozakiewicz R, Johnson EW. Central loop of the H Reflex. Am J Phys Med Rehabil. 1997; 76:182184.

  • 56.

    Press JM, Wiesner SL, MacLean IC. Electrodiagnostic evaluation of lumbar spine problems. Phys Med Rehab Clinics of NA. 1991; 2:6177.

  • 57.

    Robinson L. EMG, MRI, and radiculopathy: it's time to focus on specificity (editorial). Muscle Nerve. 1999; 22:149150.

  • 58.

    Sabbahi MA, Khalil M. Segmental H-reflex studies in upper and lower limbs of healthy subjects. Arch Phys Med Rehabil. 1990; 71:216227.

    • Search Google Scholar
    • Export Citation
  • 59.

    Schmidt K, Chinea NM, Sorenson EJ, et al. Accuracy of diagnoses delivered by an automated hand-held NC device in comparison to standard electrophysiological testing in patients with unilateral leg symptoms. Muscle Nerve. 2011; 43:913.

    • Search Google Scholar
    • Export Citation
  • 60.

    Singh A, Sommer HM. Sensory nerve conduction studies of the L1/L2 dorsal rami. Arch Phys Med Rehabil. 1996; 77:913915.

  • 61.

    Snowden ML, Kasenkorn JK, Kraft GH, et al. Dermatomal somatosensory evoked potentials in the diagnosis of lumbosacral spinal stenosis. Muscle Nerve. 1992; 15:10361044.

    • Search Google Scholar
    • Export Citation
  • 62.

    Stein B. Lumbar disk diagnosis (editorial). Ann Neurol. 1984; 41:593.

  • 63.

    Stein J, Baker E, Pine ZM. Medial paraspinal muscle electromyography: techniques of examination. Arch Phys Med Rehabil. 1993; 74:497500.

    • Search Google Scholar
    • Export Citation
  • 64.

    Tsao BE, Levin KH, Bodner RA. Comparison of surgical and electrodiagnostic findings in single root lumbosacral radiculopathies. Muscle Nerve. 2003;27:6064.

    • Search Google Scholar
    • Export Citation
  • 65.

    Tong HC. Incremental ability of needle EMG to detect radiculopathy in patients with radiating LBP using different diagnostic criteria. Arch Phys Med Rehabil. 2012;9:990992.

    • Search Google Scholar
    • Export Citation
  • 66.

    Wells MD, Meyer AP, Emley M, et al. Detection of lumbosacral nerve root compression with a novel composite nerve conduction measurement. Spine. 2002;27:28112819.

    • Search Google Scholar
    • Export Citation
  • 67.

    Wilbourn AJ, Aminoff MJ. Electrophysiologic examination in patients with radiculopathies. Muscle Nerve. 1988; 11:10991114.

  • 68.

    Wilbourn AJ, Aminoff MJ. Electrodiagnostic examination in patients with radiculopathies. Muscle Nerve. 1998; 21:16121631.

  • 69.

    Witt I, Vestergaard A, Rosenklint A. A comparative analysis of x-ray findings of the lumbar spine in patients with and without lumbar pain. Spine. 1984; 3:298300.

    • Search Google Scholar
    • Export Citation
  • 70.

    Wu PBJ, Kingery WS, Frazier ML, et al. Electrophysiological demonstration of polysegmental innervation in the lumbar medial paraspinal muscles. Muscle Nerve. 1997; 20:113115.

    • Search Google Scholar
    • Export Citation
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