Poster 90: Relationship Between EMG Findings and Changes in Extremity and Axial Pain in Patients...
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Poster 90 Relationship Between EMG Findings and Changes in Extremity and Axial Pain in Patients Undergoing Surgical Decompression Procedures. Nayan Patel, MD (Texas Back Institute, Plano, TX); Jason M. Marchetti, MD; Donna D. Ohnmeiss, PhD; Sunita Verma-Kurvari, PhD. Disclosures: N. Patel, None. Objective: The purpose of this study was to investigate the relationship between EMG findings and changes in extremity and axial pain following surgical spinal decompression pro- cedures. Design: This study was based on a retrospective chart review. Setting: Patients were treated at a multi-site spine-specialty clinic. Outcome data from patients who did not have mini- mum 1-year follow-up were collected through a mailed ques- tionnaire. Participants: The study population included 55 patients (16 cervical and 39 lumbar). Interventions: Only patients who underwent decompres- sive spinal surgery within 6 months after EMG testing were included. Main Outcome Measures: The primary clinical out- come measures were visual analog scales (VAS) separately assessing extremity and axial pain, each on a 0 to 10 scale. EMGs were classified as positive (n 27), negative (n 20), or equivocal (n 8; due to the low number, this group was excluded from the analysis). Patients whose extremity VAS score was greater than their axial score were considered to have primarily extremity pain. If the axial score was greater, they were classified as having primarily axial pain. Patients with less than 1 point difference between extremity and axial pain were grouped. The mean percentage improvement from pre- to postoperative follow-up VAS scores were compared in the positive and negative EMG groups. Results: Among patients with primarily extremity pain, those with a positive EMG had 78.1% improvement at fol- low-up in their extremity. This was significantly greater than the 20.0% improvement noted in extremity pain patients with a negative EMG (P .05; t-test). Among patients classified as primarily having axial pain, there was no signif- icant difference in the percentage improvement in axial pain when comparing patients with positive to those with negative EMGs (51.4% vs. 51.8%; P .4). Conclusions: Results of this study found that among pa- tients with primarily extremity pain, those with a positive EMG had significantly greater improvement in pain scores after decompressive surgery than those with negative EMGs. Further investigation into the relationship of EMG findings in extremity and axial pain patients is warranted in larger pop- ulations. Keywords: Clinical outcome, EMG, Decompressive sur- gery. Poster 91 Root Avulsion and Abnormal EMG Findings after C6, 7, and T1 Fractures: A Case Report. Erin W. Derbigny, MD (UT Southwestern-Dallas, Dallas, TX); Tanisha A. Toaston, DO. Disclosures: E. W. Derbigny, None. Patients or Programs: A 44-year-old man with bilateral hand weakness, numbness, and digit contractures (Ulnar Benediction sign) after cervical fractures and incomplete tetraplegia. Program Description: The patient was referred for elec- trodiagnostic studies to evaluate the etiology of his residual symptoms following traumatic cervical spine fractures surgi- cally stabilized with anterior and posterior cervical fusion surgeries. After a thorough history and physical examination, upper extremity nerve conduction study (NCS) and EMG examination, were done in standard fashion. Bilateral median and ulnar sensory nerve studies, bilateral median and ulnar motor nerve studies, as well as F-waves were performed. Selected muscles of the right upper extremity were screened via EMG. Cervical paraspinal muscles were not examined due to the patient’s recent surgery. Setting: Electromyography (EMG) laboratory. Results: NCS findings revealed normal sensory responses with severely decreased compound motor action potential (CMAP) amplitudes. EMG revealed severe, ongoing and chronic, denervation changes, noted in abductor pollicis brevis (APB), first dorsal interosseus, extensor indicis pro- prius, and flexor carpi radialis muscles. In the APB, there was complete absence of voluntary motor units. Final impression: A severe, ongoing and chronic, axonal injury to the right C8, T1, and possibly C7 nerve roots. Discussion: The above findings are consistent with “root avulsion”; described as an injury localized proximally to the dorsal root ganglion (DRG) and at or distal to the alpha motor neuron. These lesions would be located at the nerve root level, as it exits the spinal cord. Root avulsion injuries are common in traction or traumatic injuries such as the motor cycle collision injury that this patient sustained. Conclusions: EMG studies are helpful in revealing evi- dence of preganglionic or postganglionic injuries to nerve roots. The above case report illustrates the presentation of a spinal cord injured patient with associated severe lower motor neuron injury as well. Keywords: Electromyography, Electrodiagnosis, Nerve root avulsion. Poster 92 Sciatic Neuropathy in a Patient After Acupuncture Treatment: A Case Report. Ryan Pfeifer, DO (Thomas Jefferson University Hospital, Philadelphia, PA); Zach Broyer, MD; Theodore D. Conliffe, MD; Mitchell Freedman, DO. Disclosures: R. Pfeifer, None. S143 PM&R Vol. 1, Iss. 9S, 2009
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Transcript of Poster 90: Relationship Between EMG Findings and Changes in Extremity and Axial Pain in Patients...
Poster 90
Relationship Between EMG Findings andChanges in Extremity and Axial Pain inPatients Undergoing Surgical DecompressionProcedures.Nayan Patel, MD (Texas Back Institute, Plano, TX);Jason M. Marchetti, MD; Donna D. Ohnmeiss,PhD; Sunita Verma-Kurvari, PhD.
Disclosures: N. Patel, None.Objective: The purpose of this study was to investigate therelationship between EMG findings and changes in extremityand axial pain following surgical spinal decompression pro-cedures.Design: This study was based on a retrospective chartreview.Setting: Patients were treated at a multi-site spine-specialtyclinic. Outcome data from patients who did not have mini-mum 1-year follow-up were collected through a mailed ques-tionnaire.Participants: The study population included 55 patients(16 cervical and 39 lumbar).Interventions: Only patients who underwent decompres-sive spinal surgery within 6 months after EMG testing wereincluded.Main Outcome Measures: The primary clinical out-come measures were visual analog scales (VAS) separatelyassessing extremity and axial pain, each on a 0 to 10 scale.EMGs were classified as positive (n � 27), negative (n � 20),or equivocal (n � 8; due to the low number, this group wasexcluded from the analysis). Patients whose extremity VASscore was greater than their axial score were considered tohave primarily extremity pain. If the axial score was greater,they were classified as having primarily axial pain. Patientswith less than 1 point difference between extremity and axialpain were grouped. The mean percentage improvement frompre- to postoperative follow-up VAS scores were compared inthe positive and negative EMG groups.Results: Among patients with primarily extremity pain,those with a positive EMG had 78.1% improvement at fol-low-up in their extremity. This was significantly greater thanthe 20.0% improvement noted in extremity pain patientswith a negative EMG (P � .05; t-test). Among patientsclassified as primarily having axial pain, there was no signif-icant difference in the percentage improvement in axial painwhen comparing patients with positive to those with negativeEMGs (51.4% vs. 51.8%; P � .4).Conclusions: Results of this study found that among pa-tients with primarily extremity pain, those with a positiveEMG had significantly greater improvement in pain scoresafter decompressive surgery than those with negative EMGs.Further investigation into the relationship of EMG findings inextremity and axial pain patients is warranted in larger pop-ulations.Keywords: Clinical outcome, EMG, Decompressive sur-gery.
Poster 91
Root Avulsion and Abnormal EMG Findingsafter C6, 7, and T1 Fractures: A Case Report.Erin W. Derbigny, MD (UT Southwestern-Dallas,Dallas, TX); Tanisha A. Toaston, DO.
Disclosures: E. W. Derbigny, None.Patients or Programs: A 44-year-old man with bilateralhand weakness, numbness, and digit contractures (UlnarBenediction sign) after cervical fractures and incompletetetraplegia.Program Description: The patient was referred for elec-trodiagnostic studies to evaluate the etiology of his residualsymptoms following traumatic cervical spine fractures surgi-cally stabilized with anterior and posterior cervical fusionsurgeries. After a thorough history and physical examination,upper extremity nerve conduction study (NCS) and EMGexamination, were done in standard fashion. Bilateral medianand ulnar sensory nerve studies, bilateral median and ulnarmotor nerve studies, as well as F-waves were performed.Selected muscles of the right upper extremity were screenedvia EMG. Cervical paraspinal muscles were not examineddue to the patient’s recent surgery.Setting: Electromyography (EMG) laboratory.Results: NCS findings revealed normal sensory responseswith severely decreased compound motor action potential(CMAP) amplitudes. EMG revealed severe, ongoing andchronic, denervation changes, noted in abductor pollicisbrevis (APB), first dorsal interosseus, extensor indicis pro-prius, and flexor carpi radialis muscles. In the APB, there wascomplete absence of voluntary motor units. Final impression:A severe, ongoing and chronic, axonal injury to the right C8,T1, and possibly C7 nerve roots.Discussion: The above findings are consistent with “rootavulsion”; described as an injury localized proximally to thedorsal root ganglion (DRG) and at or distal to the alpha motorneuron. These lesions would be located at the nerve rootlevel, as it exits the spinal cord. Root avulsion injuries arecommon in traction or traumatic injuries such as the motorcycle collision injury that this patient sustained.Conclusions: EMG studies are helpful in revealing evi-dence of preganglionic or postganglionic injuries to nerveroots. The above case report illustrates the presentation of aspinal cord injured patient with associated severe lowermotor neuron injury as well.Keywords: Electromyography, Electrodiagnosis, Nerveroot avulsion.
Poster 92
Sciatic Neuropathy in a Patient AfterAcupuncture Treatment: A Case Report.Ryan Pfeifer, DO (Thomas Jefferson UniversityHospital, Philadelphia, PA); Zach Broyer, MD;Theodore D. Conliffe, MD; Mitchell Freedman, DO.
Disclosures: R. Pfeifer, None.
S143PM&R Vol. 1, Iss. 9S, 2009
