Predicting Response to Epidural Steroid Injections for Lumbar Spinal Stenosis with Biomarkers and Electromyography

Lin, Chung‐Kuang; Borresen, Aleks; Kroll, Mitchell; Annaswamy, Thiru M.

doi:10.1002/pmrj.12272

Cited by 4 publications

(10 citation statements)

References 21 publications

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“…A flow diagram of the study-selection process is depicted in Figure 1. Eight studies met inclusion and exclusion criteria: four retrospective cohort studies, [17][18][19][20] three prospective cohort studies, [21][22][23] and one mixed prospective and retrospective cohort study 24 (Table 1).…”

Section: Characteristics Of Included Studiesmentioning

confidence: 99%

“…In three studies, the EMG tecnicians were certified by the American Board of Electrodiagnostic Medicine (ABEM), [21][22][23] but the ABEM board-certified status of those in the remaining five studies had not been specified. [17][18][19]24 In seven studies, [17][18][19][20][21][22]24 five to six paravertebral and lower-extremity muscles had been screened.…”

Section: Emg and Radiculopathymentioning

confidence: 99%

“…Criteria for Neg-EMG included the absence of Pos-EMG radicular findings or definitive findings of an alternative diagnosis, such as peripheral neuropathy. In four studies, 18,20,21,23 criteria for Eqv-EMG included denervation in a single muscle instead of two, limb-musculature denervation with the absence of paraspinal musculature findings, or if another peripheral process could not be reliably excluded as an alternative diagnosis.…”

Section: Emg and Radiculopathymentioning

confidence: 99%

“…Lin et al 23 performed a prospective cohort study of eleven adults with LS radiculopathy due to lumbar spinal stenosis who received an interlaminar ESI. The Eqv-EMG and Pos-EMG groups were combined, and one individual in the Eqv-EMG group did not receive an ESI or complete all follow-up assessments.…”

Section: Significant Associations Between Pos-emg and Esi Outcomesmentioning

confidence: 99%

“…The risk-of-bias assessment demonstrated that five studies had a moderate risk of bias, [17][18][19][20]24 two serious risks, 21,23 and one a critical risk of bias 22 (Table 2). Three studies were judged as having moderate risk of bias for confounding because of poor reporting, 24 planned use of multiple interventions, 18 or planned use of interventions due to aspecific treatment effects.…”

Section: Risk Of Biasmentioning

confidence: 99%

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Electromyography and Therapeutic Response to Lumbosacral Epidural Steroid Injections: A Systematic Review

Meiling¹,

Moman

Pagan-Rosado³

et al. 2021

JPR

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The association between electromyography (EMG)-confirmed lumbosacral (LS) radiculopathy and pain outcomes following epidural steroid injection (ESI) has not been systematically summarized. The primary objective of this systematic review was to summarize the effects of EMG-confirmed LS radiculopathy on pain intensity following ESI. A secondary objective was to summarize the effects of EMG-confirmed LS radiculopathy on physical functioning following ESI. An a priori protocol was registered and a database search conducted by a reference librarian from January 2000 through December 2020. The search was date-limited to ensure the results of the systematic review represented contemporary clinical practice. Study-inclusion criteria included randomized trials, prospective and retrospective studies, cross-sectional studies, case series, and case reports, age ≥18 years, and use of EMG as a prognostic tool prior to an ESI. Two independent reviewers screened all titles, abstracts, and full texts. Data were extracted using a templated electronic database. The risk of bias was assessed using the Risk of Bias in Nonrandomized Studies of Interventions tool and certainty in evidence assessed using the Grading of Recommendations, Assessment, Development, and Evaluation approach. Due to clinical heterogeneity in study characteristics, a meta-analysis was not performed. A total of 454 studies were screened, and eight nonrandomized studies met the inclusion criteria. Five studies had a moderate risk of bias, two serious risks, and one a critical risk. The key findings included four of eight nonrandomized studies reporting a significant association between EMG-confirmed radiculopathy and ESI response and four of eight nonrandomized studies reporting no significant association. Important sources of bias limited interpretation of individual study findings, and multiple sources of clinical heterogeneity limited between-study comparisons. The findings of this systematic review demonstrate that associations existed between EMG-confirmed LS radiculopathy and pain outcomes after ESI in some, but not all studies. These results should be carefully interpreted with full understanding of the risk of bias and very low certainty in evidence that characterize the nonrandomized studies comprising this systematic review.

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Section: Characteristics Of Included Studiesmentioning

confidence: 99%

Section: Emg and Radiculopathymentioning

confidence: 99%

Section: Emg and Radiculopathymentioning

confidence: 99%

Section: Significant Associations Between Pos-emg and Esi Outcomesmentioning

confidence: 99%

Section: Risk Of Biasmentioning

confidence: 99%

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Electromyography and Therapeutic Response to Lumbosacral Epidural Steroid Injections: A Systematic Review

Meiling¹,

Moman

Pagan-Rosado³

et al. 2021

JPR

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Serial electrodiagnostic testing: Utility and indications in adult neurological disorders

Hearn,

Stino,

Howard

et al. 2024

Muscle and Nerve

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Although existing guidelines address electrodiagnostic (EDX) testing in identifying neuromuscular conditions, guidance regarding the uses and limitations of serial (or repeat) EDX testing is limited. By assessing neurophysiological change longitudinally across time, serial electrodiagnosis can clarify a diagnosis and potentially provide valuable prognostic information. This monograph presents four broad indications for serial electrodiagnosis in adult peripheral neurological disorders. First, where clinical change has raised suspicion for a new or ongoing lesion, EDX reassessment for spatial spread of abnormality, involvement of previously normal muscle or nerve, and/or evolving pathophysiology can clarify a diagnosis. Second, where diagnosis of a progressive neuromuscular condition is uncertain, electrophysiological data from a second time point can confirm or refute suspicion. Third, to establish prognosis after a static nerve injury, a repeat study can assess the presence and extent of reinnervation. Finally, faced with a limited initial study (as when complicated by patient or environmental factors), a repeat EDX study can supplement missing or limited data to provide needed clarity. Repeat EDX studies carry certain limitations, however, such as with prognostication in the setting of remote or chronic lesions, sensory predominant fascicular injury, or mild axonal injury. Nevertheless, serial electrodiagnosis remains a valuable and underused tool in the diagnostic and prognostic evaluation of neuromuscular conditions.

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Electromyography in the Spine Patient

Kocak

Annaswamy

2022

Multidisciplinary Spine Care

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Predicting Response to Epidural Steroid Injections for Lumbar Spinal Stenosis with Biomarkers and Electromyography

Cited by 4 publications

References 21 publications

Electromyography and Therapeutic Response to Lumbosacral Epidural Steroid Injections: A Systematic Review

Electromyography and Therapeutic Response to Lumbosacral Epidural Steroid Injections: A Systematic Review

Serial electrodiagnostic testing: Utility and indications in adult neurological disorders

Electromyography in the Spine Patient

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