The Sensitivity and Specificity of Electrodiagnostic Testing for the Clinical Syndrome of Lumbar Spinal Stenosis

Haig, Andrew J.; Tong, Henry C.; Yamakawa, Karen; Quint, Douglas J.; Hoff, Julian T.; Chiodo, Anthony; Miner, Jennifer A.; Choksi, Vaishali R.; Geisser, Michael E.

doi:10.1097/01.brs.0000188400.11490.5f

Cited by 98 publications

(79 citation statements)

References 36 publications

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“…More advanced disease may demonstrate significantly decreased nerve conduction, with axonal loss and evidence of demyelination in a multi-radicular pattern [16][17][18][19] . treatment Before any treatment proposal, it is important to know the natural history of the disease.…”

Section: Radiological Findingsmentioning

confidence: 99%

Degenerative lumbar stenosis: update

Joaquim

Sansur

Hamilton

et al. 2009

Arq. Neuro-Psiquiatr.

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-We present a literature review of the diagnosis and treatment of acquired lumbar spinal stenosis (LS), with a brief description of new surgical techniques. LS is the most common cause of spinal surgery in individuals older than 65 years of age. Neurogenic claudication and radiculopathy result from compression of the cauda equina and lumbosacral nerve roots by degenerated spinal elements. Surgical decompression is a well established treatment for patients with refractory, or moderate to severe clinical symptoms. However, the variety of surgical options is vast. New techniques have been developed with the goal of increasing long term functional outcomes. In this article we review lumbar decompression and fusion as treatment options for LS but also present other recent developments. Prospective long term studies are necessary to know which procedures would result in optimal patient outcome.Key WordS: acquired lumbar stenosis, surgical treatment, new techniques, fusion. estenose lombar degenerativa: atualização resumo -Apresentamos uma revisão de literatura do diagnóstico e tratamento da estenose lombar (eL) adquirida, enfatizando as novas técnicas de manejo cirúrgico. A eL é a causa mais comum de cirurgia na coluna de pacientes com mais de 65 anos de idade. Claudicação neurogênica e radiculopatias são sintomas resultantes da compressão das raízes lombossacrais pelos elementos degenerados. A descompressão cirúrgica é um procedimento bem estabelecido para pacientes com sintomas severos ou refratários ao tratamento clínico. Contudo, as opções cirúrgicas são amplas. Novas técnicas de fusão e artrodese são úteis para melhorar os resultados funcionais. Neste artigo, varias alternativas cirúrgicas são apresentadas, incluindo as novas tecnologias na área. evidências científicas mais contundentes com seguimento longo são necessárias para a incorporação destas práticas na atividade médica de rotina.PALAvrAS-CHAve: estenose lombar adquirida, tratamento cirúrgico, novas técnicas, fusão.

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Section: Radiological Findingsmentioning

confidence: 99%

Degenerative lumbar stenosis: update

Joaquim

Sansur

Hamilton

et al. 2009

Arq. Neuro-Psiquiatr.

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“…We are aware that EMG studies including paraspinal recordings were shown to be sensitive in lumbar spinal canal stenosis [23]. Such EMG recordings become positive as soon as an axonal nerve root damage is established.…”

Section: Discussionmentioning

confidence: 98%

Lumbar spinal stenosis: Assessment of cauda equina involvement by electrophysiological recordings

et al. 2007

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Whereas the clinical examination, even in severe LSS, showed no specific sensory-motor deficit, the electrophysiological recordings indicated that the majority of patients had a neurogenic disorder within the lumbar spine. By the pattern of bilateral pathological tibial SSEP and pathological reflexes associated with normal peripheral nerve conduction, LSS can be separated from a demyelinating polyneuropathy and mono-radiculopathy. The applied electrophysiological recordings, especially SSEP, can confirm a neurogenic claudication due to cauda equina involvement and help to differentiate neurogenic from vascular claudication or musculo-skeletal disorders of the lower limbs. Therefore, electro-physiological recordings provide additional information to the neurological examination when the clinical relevance of a radiologically-suspected LSS needs to be confirmed.

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“…These processes represent common flaws during the differential diagnosis of atypical claudication, because imaging studies are not specific for LSS [19]. Although electrodiagnostic testing is highly specific for the diagnosis of LSS [20], its clinical utilization is limited due to the high cost and invasiveness.…”

Section: Discussionmentioning

confidence: 99%

The validity of ankle-brachial index for the differential diagnosis of peripheral arterial disease and lumbar spinal stenosis in patients with atypical claudication

et al. 2011

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Purpose Claudication is a typical symptom of peripheral arterial disease (PAD) and lumbar spinal stenosis (LSS). Differential diagnosis of PAD and LSS is often difficult due to the subjective natures of symptoms and atypical signs. The authors aimed to determine the usefulness of ankle-brachial index (ABI) measurement for the differential diagnosis of PAD and LSS when the etiology of claudication is uncertain. Methods Forty-two consecutive patients who had been referred by spine surgeons to a lower extremity vascular surgeon for atypical claudication were retrospectively analyzed. Atypical claudication was defined as claudication not caused by PAD, as determined by clinical manifestations, or by LSS, as determined by MR imaging. A final diagnosis of PAD was established by CT angiography (CTA) and of LSS by excluding PAD. Diagnostic validity of ABI for PAD in atypical presentation was assessed. Results Sixty-two legs of 42 atypical claudication patients were analyzed. Mean patient age was 65.8 ± 8.2 years (38-85) and 29 (69.0%) had diabetes mellitus. Mean ABI was 0.73 ± 0.14 (0.53-0.94) in the PAD group and 0.92 ± 0.18 (0.52-1.10) in the LSS group (P \ 0.001). Of the 33 legs with a low ABI (ABI \ 0.9), 29 legs were diagnosed as true positives for PAD by CTA and 4 were false positives, and of the 29 legs with a high ABI, 5 were false negatives and 24 were true negatives. The sensitivity and specificity of ABI for the diagnosis of PAD in patients with atypical claudication were 85.3 and 85.7%, respectively, and its positive and negative predictive values were 87.9 and 82.8%. Conclusions ABI is a recommended screening test for the differential diagnosis of lower leg claudication when clinical symptoms are atypical.

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The Sensitivity and Specificity of Electrodiagnostic Testing for the Clinical Syndrome of Lumbar Spinal Stenosis

Cited by 98 publications

References 36 publications

Degenerative lumbar stenosis: update

Degenerative lumbar stenosis: update

Lumbar spinal stenosis: Assessment of cauda equina involvement by electrophysiological recordings

The validity of ankle-brachial index for the differential diagnosis of peripheral arterial disease and lumbar spinal stenosis in patients with atypical claudication

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