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Electromyographic and Magnetic Resonance Imaging to Predict Lumbar Stenosis, Low-Back Pain, and No Back Symptoms

¹ Departments of Physical Medicine and Rehabilitation (A.J.H., M.E.G., H.C.T., K.S.J.Y., A.C., and J.A.M.), Neurosurgery (J.T.H.), Radiology (D.J.Q. and V.V.P.), and Orthopedic Surgery (A.J.H.), University of Michigan, 325 East Eisenhower Parkway, Ann Arbor, MI 48108. E-mail address for A.J. Haig: andyhaig{at}umich.edu

Investigation performed at the University of Michigan Spine Program, Ann Arbor, Michigan

Disclosure: In support of their research for or preparation of this work, one or more of the authors received, in any one year, grants in excess of $10,000 from the National Institutes of Health (5 R01 NS41855-02 and R01 NS17760). Neither they nor a member of their immediate families received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, division, center, clinical practice, or other charitable or nonprofit organization with which the authors, or a member of their immediate families, are affiliated or associated.

The opinions contained in this publication are those of the authors and do not necessarily reflect those of the United States Department of Health and Human Services. The work was originally presented at the International Society of Physical and Rehabilitation Medicine Congress, Sao Paulo, Brazil, April 15, 2005.

Methods: One hundred and fifty persons between the ages of fifty-five and eighty years old, including asymptomatic volunteers and persons referred for lumbar magnetic resonance imaging, underwent clinical examination, electrodiagnosis, and magnetic resonance imaging. Subjects were excluded if they had neuromuscular disease, sacral cancer, or inadequate test results, which left 126 subjects for the final analysis. The final cohort was divided into three groups—no back pain, mechanical back pain, and clinical spinal stenosis—on the basis of the impression of the examining physician, for whom the results of the magnetic resonance imaging and electrodiagnostic testing were masked. A spine surgeon also reviewed both the imaging and clinical examination data.

Results: The examining physician's diagnosis of clinical spinal stenosis was significantly related to the neurological findings on examination (p < 0.05) and to the spine surgeon's diagnosis (p < 0.001). The diagnosis of clinical spinal stenosis was also significantly related to the presence of fibrillations on electrodiagnostic testing (p 0.003), the minimum anteroposterior diameter of the spinal canal on the magnetic resonance images (p = 0.016), and the average of the two smallest spinal canal diameters (p = 0.008) on the images. Measurements on magnetic resonance imaging did not differentiate subjects with clinical spinal stenosis from controls better than chance, whereas paraspinal mapping electrodiagnosis scores did.

Conclusions: This prospective, controlled, masked study of electrodiagnosis and magnetic resonance imaging for older subjects showed that imaging does not differentiate symptomatic from asymptomatic persons, whereas electrodiagnosis does. We believe that radiographic findings alone are insufficient to justify treatment for spinal stenosis.

Level of Evidence: Diagnostic Level IV. See Instructions to Authors for a complete description of levels of evidence.

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