Takao Murohashi1, Mitsunori Yoshimoto2, Tsuneo Takebayashi3, Shuichi Hashimoto1, Shouto Yamada1, Hiroyuki Takashima4, Toshihiko Yamashita3. 1. Department of Clinical Engineering, Sapporo Medical University Hospital, S1 W16, Sapporo, Hokkaido, 060-8543, Japan. 2. Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, S1 W16, Sapporo, Hokkaido, 060-8543, Japan. myoshimo@sapmed.ac.jp. 3. Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, S1 W16, Sapporo, Hokkaido, 060-8543, Japan. 4. Division of Radiology and Nuclear Medicine, Sapporo Medical University Hospital, S1 W16, Sapporo, Hokkaido, 060-8543, Japan.
Abstract
PURPOSE: The measurement of distal motor latency (DML) is an established method for diagnosing entrapment peripheral neuropathy. DML can also serve as an index for disease severity and prognosis. We considered that measuring DML could be useful in estimating the severity of spinal root impairment and predicting prognosis in patients with lumbar spinal stenosis (LSS). The purpose of this study was to investigate the efficacy of intraoperative direct electrical stimulation of the spinal root and the measurement of DML in LSS. METHODS: In 39 patients with LSS, a total of 93 spinal roots were stimulated, and evoked electromyography was recorded at the leg muscles after decompression. DML was measured and its correlation with clinical severity, as evaluated by Zurich claudication questionnaire (ZCQ) and Short Form 36 (SF-36), was investigated. RESULTS: For the stimulation of the L3, L4, and L5 spinal root, the mean DML (ms) were 6.8 (±1.4), 7.4 (±1.3), and 6.0 (±1.3) in gluteus medius, 9.3 (±1.5), 9.2 (±1.5), and 9.0 (±1.6) in biceps femoris, 9.7 (±1.0), 9.8 (±1.8), and 9.4 (±1.2) in vastus medialis, 16.1 (±1.0), 14.7 (±1.3), and 14.1 (±1.5) in tibialis anterior, and 16.4 (±1.4), 14.3 (±1.8), and 13.9 (±1.9) in gastrocnemius muscles. Statistically significant positive correlations were observed between DML and height. Preoperative symptom and function scores of ZCQ and postoperative bodily pain scores of SF-36 were significantly worse in the patients with prolonged DML. CONCLUSIONS: DML is thought to be useful for estimating the severity of spinal root impairment and for predicting the prognosis.
PURPOSE: The measurement of distal motor latency (DML) is an established method for diagnosing entrapment peripheral neuropathy. DML can also serve as an index for disease severity and prognosis. We considered that measuring DML could be useful in estimating the severity of spinal root impairment and predicting prognosis in patients with lumbar spinal stenosis (LSS). The purpose of this study was to investigate the efficacy of intraoperative direct electrical stimulation of the spinal root and the measurement of DML in LSS. METHODS: In 39 patients with LSS, a total of 93 spinal roots were stimulated, and evoked electromyography was recorded at the leg muscles after decompression. DML was measured and its correlation with clinical severity, as evaluated by Zurich claudication questionnaire (ZCQ) and Short Form 36 (SF-36), was investigated. RESULTS: For the stimulation of the L3, L4, and L5 spinal root, the mean DML (ms) were 6.8 (±1.4), 7.4 (±1.3), and 6.0 (±1.3) in gluteus medius, 9.3 (±1.5), 9.2 (±1.5), and 9.0 (±1.6) in biceps femoris, 9.7 (±1.0), 9.8 (±1.8), and 9.4 (±1.2) in vastus medialis, 16.1 (±1.0), 14.7 (±1.3), and 14.1 (±1.5) in tibialis anterior, and 16.4 (±1.4), 14.3 (±1.8), and 13.9 (±1.9) in gastrocnemius muscles. Statistically significant positive correlations were observed between DML and height. Preoperative symptom and function scores of ZCQ and postoperative bodily pain scores of SF-36 were significantly worse in the patients with prolonged DML. CONCLUSIONS:DML is thought to be useful for estimating the severity of spinal root impairment and for predicting the prognosis.
Authors: Constantin Schizas; Nicolas Theumann; Alexandre Burn; Rosamond Tansey; Douglas Wardlaw; Francis W Smith; Gerit Kulik Journal: Spine (Phila Pa 1976) Date: 2010-10-01 Impact factor: 3.468
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