Monograph: Evaluation of persons with suspected lumbosacral and cervical radiculopathy: Electrodiagnostic assessment and implications for treatment and outcomes (Part II)-MUS27008

MUS27008

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In Part II of the AANEM Monograph on the evaluation of persons with suspected lumbosacral and cervical radiculopathy, the authors discuss the implications of electrodiagnostic findings for the diagnosis, clinical management, and treatment outcomes of patients with radiculopathy. The most important means of testing for radiculopathy is the electrodiagnostic examination with needle electromyography (EMG), which has high specificity but modest sensitivity. EMG confirmed lumbo-sacral radiculopathy is associated with better clinical outcomes for persons undergoing conservative management and better response to epidural corticosteroid injections. Pre-operative EMG for radiculopathy is also associated with better outcomes for persons undergoing spine surgery. The authors emphasize the importance of needle EMG examination of the paraspinal muscles for localizing the site of pathology in the spine or root level. They caution against over-diagnosing radiculopathies based on reduced recruitment or increased polyphasicity of the paraspinal muscles. The authors also discuss the relationship between symptom duration and the probability of finding fibrillation potentials in the muscles, noting that there is no significant relationship between the two. They emphasize the valuable role of needle EMG in predicting outcomes after epidural steroid injections and surgical management. The authors highlight the complex underlying pathophysiology of radiculopathy, with various intrinsic and extrinsic causes. They emphasize that lumbosacral and cervical radiculopathy usually resolve with conservative management and that surgery is not needed for the majority of cases. Finally, the authors discuss the importance of accurate diagnosis and emphasize the downsides of over-diagnosing radiculopathy, such as excessive surgical rates and the contribution to the opioid epidemic.

Keywords

AANEM Monograph

radiculopathy

electrodiagnostic examination

needle electromyography

conservative management

epidural corticosteroid injections

spine surgery

paraspinal muscles

fibrillation potentials

accurate diagnosis