Wasting of extensor digitorum brevis as a decisive preoperative clinical indicator of lumbar canal stenosis: A single-center prospective cohort study

Abstract

Background:The dilemma in managing patients with low back ache lies in differentiating radiculopathy from lumbar canal stenosis. This has a huge bearing in patients being planned for surgical intervention as underperforming leads to failed back syndrome whereas over-doing leads to instability. There still remains a loophole in clinically diagnosing lumbar canal stenosis.Aim:We opt to utilize a simple bedside clinical examination in routinely assessing patients presenting with low back ache in ruling out underlying canal stenosis.Subjects and Methods:We performed a prospective study on 120 consecutive patients presenting with low back ache in the spine clinic. Each of them was neurologically examined and thoroughly assessed for wasting of extensor digitorum brevis (EDB) muscles. These were then correlated with the radio-imaging and the intraoperative findings.Results:Lumbar canal stenosis was mostly observed in the age group of 50–60 years. Diagnosis for L3/4 canal stenosis was made in 44/120 (36.6%), L5-S1 in 52/120 (43.3%), and L3/L4/L5 level in 48/120 (40%) of patients. EDB wasting was seen unilaterally in 72/120 (60%) and bilaterally in 36/120 (30%) of the study group.Conclusion:This study appraises the clinical implication of observing for the wasting of EDB muscle so as to aid in the diagnosis of lumbar canal stenosis. This simple bedside clinical pearl can help us in predicting the need of further imaging studies and also in taking right therapeutic decision.

A Retrospective Observational Analysis on the Outcome of Microlumbar Discectomy among 70 Consecutive Cases in the Tertiary Care Spine Center in Nepal

“…Patients who needed laminectomy for disc removal and patients with symptomatic lumbar canal stenosis as evident by the presence of bilateral Extensor Digitorum Brevis (EDB) wasting in clinical examination and equivocal fi ndings in radio-imaging 20 were excluded from the study.…”

Bilateral atrophy of the extensor digitorum brevis muscle might be a useful sign for diagnosing diabetic polyneuropathy in Japanese men who do not sit in the traditional “seiza” style

“…EDB atrophy (EDBA) is easily detected in <30 s when EDB bulk cannot be identified by inspection and palpation at the position of toe extension. EDBA has been reported to be a sign of anterior tarsal tunnel syndrome 4 , L5 radiculopathy 5 , lumbar canal stenosis 6 and DSPN 7 . EDBA is also reported to be due to the traditional habit of sitting on the floor, cross‐legged or kneeling and sitting over one’s feet 8 .…”