The electrodiagnostic evaluation of patients with suspected cervical radiculopathy: Literature review on the usefulness of needle electromyography

Muscle and Nerve

Volumn 22, Issue 8 SUPPL. 8, 1999, Pages

  So, Yuen T ^a   Weber, Cheryl F ^a   Ball, Richard D ^a   Campbell, William W ^a  

^a NONE

Author keywords

Cervical radiculopathy; Electrodiagnosis; Electromyography; EMG; Neuromuscular disease; Spinal root compression; Spondylosis

Indexed keywords

CERVICOBRACHIAL NEURALGIA; CLINICAL PROTOCOL; DIAGNOSTIC ACCURACY; DIAGNOSTIC VALUE; DISEASE ASSOCIATION; ELECTROMYOGRAPHY; HUMAN; INTERMETHOD COMPARISON; MEDICAL LITERATURE; MEDICAL SOCIETY; MUSCLE WEAKNESS; PRIORITY JOURNAL; RADIODIAGNOSIS; REVIEW; RISK BENEFIT ANALYSIS; STANDARD;

EID: 0032816299     PISSN: 0148639X     EISSN: None     Source Type: Journal    
DOI: None     Document Type: Review

References (59)

1. American Association of Electrodiagnostic Medicine: Literature review of the usefulness of nerve conduction studies and electromyography in the evaluation of patients with ulnar neuropathy at the elbow. Muscle Nerve 1999; 22 (suppl 8) S175-S205; Background Reference.
2. American Association of Electrodiagnostic Medicine: Practice parameter for electrodiagnostic studies in carpal tunnel syndrome. Muscle Nerve 1993; 16:1390-1414.
3. American Association of Electrodiagnostic Medicine: Guidelines in Electrodiagnostic Medicine. Muscle Nerve 1999; 22 (suppl 8); Background Reference.
4. Aminoff MJ. Electromyography in clinical practice. New York, Churchill Livingstone, 1987. Background Reference.
5. Berger AR, Busis NA, Logigian EL, Wierzbicka M, Shahani BT: Cervical root stimulation in the diagnosis of radiculopathy. Neurology 1987; 37:329-332. Criteria Met (5/6: 1,2,3,5,6) Patients with cervical radiculopathy were clinically defined. In the authors' hands, cervical root stimulation was more sensitive than needle EMG examination. Root stimulation was abnormal in 27 of 34 patients, whereas needle EMG was abnormal in 16. See text.
6. Boot DA, Khan RH, Sellar RJ, Hughes SP, Kirkpatrick AE: Computed tomogram myelography in cervical spondylosis. Int Orthop 1987; 11:249-254. Criteria Met (1/6: 6) Only 9 patients.
7. Brazier MAB, Watkins AL, Michelson JJ: Electromyography in differential diagnosis of ruptured cervical disc. Arch Neurol Psychiat 1946; 56: 651-658. Criteria Met (3/6: 4,5,6) Employed only surface EMG recording.
8. Buchthal F, Guld C, Rosenfalck P: Action potential parameters in normal human muscle and their dependence on physical variables. Acta Physiol Scand 1954; 32:200-229. Background Reference.
9. Buchthal F, Rosenfalck P: Spontaneous electrical activity of human muscle. Electroencephalogr Clin Neurophyiol 1966; 20:321-336. Background Reference.
10. Chistyakov AV, Soustiel JF, Hafner H, Feinsod M: Motor and somatosensory conduction in cervical myelopathy and radiculopathy. Spine 1995; 20:2135-2140. Criteria Met (3/6: 1,2,4) A study devoted solely to motor-evoked potentials and somatosensory-evoked potentials.
11. Colachis SC, Pease WS, Johnson EW: Polyphasic motor unit action potentials in early radiculopathy: their presence and ephaptic transmission as an hypothesis. Electromyogr Clin Neurophysiol 1992; 32:27-33. Criteria Met (1/6: 6) Case reports.
12. Crane CR, Krusen EM: Significance of polyphasic potentials in diagnosis of cervical root involvement. Arch Phys Med Rehab 1968;49:403-406. Criteria Met (2/6: 4,6) Retrospective study that included 241 patients with referral diagnosis of cervical radiculopathy. Although not specifically stated, needle EMG was probably considered abnormal if any polyphasic potentials were present. Eighty-one of 87 patients with abnormal myelogram had abnormal needle EMG. Needle EMG findings correlated correctly with the affected level at surgery in 62 (90%) of 69 cases.
13. Czyrny JJ, Lawrence J: The importance of paraspinal muscle EMG in cervical and lumbrosacral radiculopathy: review of 100 cases. Electromyogr Clin Neurophysiol 1996; 36:503-508. Criteria Met (2/6: 4,5) In the authors' hands, 20 out of 49 patients with cervical radiculopathies had EMG abnormalities restricted only to the paraspinal muscles.
14. Czyrny JJ, Lawrence J: Importance of paraspinal muscle EMG in cervical and lumbrosacral radiculopathies. Amer J Phys Med Rehab 1995; 74:458-459. Same study as 13.
15. Daniels DL, Grogan JP, Johansen JG, Meyer GA, Williams AL, Haughton VM: Cervical radiculopathy: computed tomography and myelography compared. Radiology 1984; 151:109-113. Background Reference. Radiologic study. Little mention of EMG.
16. Danner R: Referral diagnosis versus electroneurophysiological finding. Two years electroneuromyographic consultation in a rehabilitation clinic. Electromyogr Clin Neurophysiol 1990; 30:153-157. Criteria Met (0/6) (Study not designed to specifically address cervical radiculopathy).
17. Date ES, Gray LA: Electrodiagnostic evidence for cervical radiculopathy and suprascapular neuropathy in shoulder pain. Electromyogr Clin Neurophysiol 1996; 36:333-339. Criteria Met (3/6: 1,4,5) Eleven of 33 patients diagnosed with a shoulder impingement syndrome had electrodiagnostic evidence suggestive of cervical radiculopathy.
18. Daube JR: AAEM Minimonograph #11: needle examination in clinical electromyography. Muscle Nerve 1991; 14:685-700. Background Reference.
19. Daube JR: Assessing the motor unit with needle electromyography, in J. R. Daube (eds): Clinical Neurophysiology. Philadelphia, F. A. Davis, 1996; 257-281. Background Reference.
20. Dillingham TR, Pezzin LE, Lauder TD: Cervical paraspinal muscle abnormalities and symptom duration: a multivariate analysis. Muscle Nerve 1998, 21:640-642. Criteria Met (2/6: 4,5) Attempt to correlate spontaneous activity in cervical paraspinal muscles with symptom duration in patients with electrodiagnostic evidence of cervical radiculopathy.
21. Eisen A: Electrodiagnosis of radiculopathies, in A. J. Aminoff (eds): Neurologic Clinics: Symposium on Electrodiagnosis. Philadelphia, W. B. Saunders, 1985, vol 3, pp. 495-510. Background Reference.
22. Eisen A, Hoirch M, Moll A: Evaluation of radiculopathies by segmental stimulation and somatosensory evoked potentials. Can J Neurol Sci 1983; 10:178-182. Criteria Met (2/6: 1{?},2) Thirty-six patients with either lumbosacral or cervical radiculopathies were included. Needle EMG had higher diagnostic yield (75%) than F waves and SEPs, and correlated better with motor deficits. See text.
23. Eisen A, Schomer D, Melmed C: The application of F-wave measurements in the differentiation of proximal and distal upper limb entrapments. Neurology 1977; 27:662-668. Criteria Met (3/6: 1,2,3) F-wave studies were abnormal in 67% of 23 patients with proximal entrapment neuropathy (including some patients with presumed cervical radiculopathy).
24. Heiskari M, Siivola J, Heikkinen ER: Somatosensory evoked potentials in evaluation of decompressive surgery of cervical spondylosis and herniated disc. Ann Clin Res 1986; 18:107-113. Criteria Met (2/6: 1,2) This study was devoted solely to SEP.
25. Heiskari M, Tolonen U, Nystrom SHM: Comparison of somatosensory evoked responses from root and cord recorded by skin and epidural electrodes using stimulation of the median nerve in cervical radiculopathy and radiculomyelopathy. Acta Neurochirurgica 1986; 79:114-119. Criteria Met (2/6: 1,2) This study was devoted solely to SEP.
26. Honet JC, Puri K: Cervical radiculitis: treatment and results in 82 patients. Arch Phys Med Rehab 1976; 57:12-16. Criteria Met (2/6: 5,6) This study discussed primarily treatment results.
27. Hong CZ, Lee S, Lum P: Cervical radiculopathy. Clinical, radiographic and EMG findings. Orthop Rev 1986; 15: 433-439. Criteria Met (4/6: 2,4,5,6) This retrospective study reviewed the clinical, plain radiographic and needle EMG findings in 108 patients with cervical radiculopathy. See text.
28. Jaskolski DJ, Jarratt JA, Jakubowski J: Clinical evaluation of magnetic stimulation in cervical spondylosis. Br J Neurosurg 1989; 3: 541-548. This is a study of only magnetic stimulation.
29. Katirji MB, Agrawal R, Kantra TA: The human cervical myotomes: an anatomical correlation between electromyography and CT/myelography. Muscle Nerve 1988; 11: 1070-1073. Criteria Met (4/6: 3,4,5,6) The radiographic findings (metrizamide myelography/computed tomography) were correlated with needle EMG findings in 20 patients. See text.
30. Khan MRH, McInnes A, Hughes SPF: Electrophysiological studies in cervical spondylosis. J Spinal Dis 1989; 2:163-169. Criteria Met (3/6: 2,3,6) Forty-four of 57 patients had needle EMG examination. An abnormality rate of 50% was seen in those patients with clinical signs, as compared to 30% in those without neurologic signs. Abnormality was seen slightly less frequently in SEP and F-wave studies. See text.
31. Kimura J: Electrodiagnosis in diseases of nerve and muscle. Philadelphia, F. A. Davis, 1989. Background Reference.
32. Lane ME: Recent developments in the electrodiagnosis of radiculopathies. Bull Hosp Joint Dis Orthop Inst 1984; 44: 56-64.
33. Lane ME, Tamhankar MN, Demopoulos JT: Discogenic radiculopathy. Use of electromyography in multidisciplinary management. NY State J Med 1978; 78:32-36.
34. Lauder TD, Dillingham TR: The cervical radiculopathy screen: optimizing the number of muscles studied. Muscle Nerve 1996; 19:662-665. Criteria Met (3/6: 3,4,5) A retrospective study of patients with electrodiagnostically confirmed radiculopathy.
35. Leblhuber F, Reisecker R, Boehm-Jurkovic H, Witzmann A, Deisenhammer E: Diagnostic value of different electrophysiologic tests in cervical disk prolapse. Neurology 1988; 38:1879-1881. Criteria Met (5/6: 1,2,3,5,6) All 24 patients had radiologically verified cervical disk prolapse. Needle EMG was abnormal in 65%, dermatomal SEP in 85%, and F wave 38%. See text.
36. Levin KH, Maggiano HJ, Wilbourn AJ: Cervical radiculopathies: comparison of surgical and EMG localization of single root lesions. Neurology 1996; 46:1022-1025. Criteria Met (2/6: 5,6) The authors identified a highly selected group of 50 patients with surgically defined solitary root compression. Needle EMG was classified as abnormal only by the presence of fibrillation potentials. A relatively stereotyped pattern of abnormalities was seen with C5, C7 and C8 radiculopathies. See text.
37. Makin GJ, Brown WF, Ebers GC: C7 radiculopathy: importance of scapular winging in clinical diagnosis. J Neurol Neurosurg Psychiat 1986; 49:640-644. Case reports.
38. Marinacci AA: A correlation between the operative findings in cervical herniated discs with the electromyograms and opaque myelograms. Electromyography 1966; 6:5-20. Criteria Met: (2/6: 2,6) There was only a brief mention of needle EMG findings.
39. Negrin P, Lelli S, Fardin P: Contribution of electromyography to the diagnosis, treatment and prognosis of cervical disc disease: a study of 114 patients. Electromyogr Clin Neurophysiol 1991; 31:173-179. Criteria Met (3/6: 3,5,6) The study included 114 patients with cervical radiculopathy and denervation on needle EMG examination. See text.
40. Newman M, Nelson N: Digital nerve sensory potentials in lesions of cervical roots and brachial plexus. Can J Neurol Sci 1983; 10:252-255. Criteria Met (2/6: 1,2) This is a study of sensory nerve conduction and F-wave studies in patients with cervical root and plexus lesions.
41. Partanen J, Partanen K, Oikarinen H, Niemitukia L, Hernesniemi J: Preoperative electroneuromyography and myelography in cervical root compression. Electromyogr Clin Neurophysiol 1991;31: 21-26. Criteria Met (5/6: 2,3,4,5,6) Seventy-seven patients with preoperative needle EMG and myelography were selected. Abnormal findings were seen in 67%, with localizing findings seen in 57%. See text.
42. Peioglou-Harmoussi S, Fawcett PR, Howel S, Barwick DD: F response frequency in motor neuron disease and cervical spondylosis. J Neurol Neurosurg Psychiat 1987; 50:593-599. Criteria Met (2/6: 1,2) The authors found no significant difference in the frequency of ulnar F-wave response between patients with cervical spondylosis and controls.
43. Perlik SJ, Fisher MA: Somatosensory evoked response evaluation of cervical spondylytic myelopathy. Muscle Nerve 1987; 10:481-489. Criteria Met (3/6: 1,2,5) Thirteen patients with cervical myelopathy were studied with tibial and median SEP. Eight patients had superimposed cervical radiculopathy and needle EMG abnormalities. Tibial SEP was abnormal in all 13 patients. Median SEP was abnormal in those with cord lesions at C5-6 or above.
44. Radhakrishnan K, Litchy WJ, O'Fallon WM, Kurland LT: Epidemiology of cervical radiculopathy. A population-based study from Rochester, Minnesota, 1976 through 1990. Brain 1994; 117:325-335. Background Reference.
45. Raps SP, Rubin M: Proximal median neuropathy and cervical radiculopathy: double crush revisited. Electromyogr Clin Neurophysiol 1994; 34:195-196. Case reports only.
46. Sabbahi MA, Khalil M: Segmental H-reflex studies in upper and lower limbs of patients with radiculopathy. Arch Phys Med Rehab 1990; 71:223-227. Criteria Met (3/6: 1,3,5) (H reflex only).
47. Schimsheimer RJ, Ongerboer de Visser BW, Kemp B: The flexor carpi radialis H reflex in lesions of the sixth and seventh cervical nerve roots. J Neurol Neurosurg Psychiat 1985; 48: 445-449. Criteria Met (1/6: 2) Extensive normal data on the H reflex of the flexor carpi radialis were presented. The H-reflex latency was abnormal only in lesions of the C6 or C7 roots.
48. Schmid UD, Hess CW, Ludin HP: Somatosensory evoked potentials following nerve and segmental stimulation do not confirm cervical radiculopathy with sensory deficit. J Neurol Neurosurg Psychiat 1988; 51:182-187. Criteria Met (2/6: 1,2) This was devoted solely to SEP.
49. Shea PA, Woods WW, Werden DH: Electromyography in diagnosis of nerve root compression syndrome. Arch Neurol Psychiat 1950; 64:93-104. Criteria Met (3/6: 4,5,6) One of the earliest investigations of needle EMG evaluation of patients with cervical radiculopathy. See text.
50. So YT, Olney RK, Aminoff MJ: A comparison of thermography and electromyography in the diagnosis of cervical radiculopathy. Muscle Nerve 1990; 13:1032-1036. Criteria Met (5/6: 1,2,3,5,6) The authors assessed the usefulness of thermography in 14 patients with clinically defined cervical radiculopathy. Needle EMG was abnormal in 71% of patients, and was found to be more sensitive and specific than thermography. See text.
51. Streib E, Daube JR: Electromyography of paraspinal muscles. Neurology 1975; 386. Abstract only.
52. Tackmann W, Radu EW: Observations on the application of electrophysiological methods in the diagnosis of cervical root compressions. Eur Neurol 1983; 22:397-404. Criteria Met (6/6: 1,2,3,4,5,6) Twenty patients with C6 and/or C7 radiculopathy were studied. Needle EMG was abnormal in 19 patients, but correlated with the clinically defined level of involvement in only 11 patients. See text.
53. Teresi LM, Lufkin RB, Reicher MA, Moffit BJ, Vinuela FV, Wilson GM: Asymptomatic degenerative disk disease and spondylosis of the cervical spine: MR imaging. Radiology 1987; 164:83-88. Background Reference.
54. Thacker AK, Misra S, Katiyar BC: Nerve conduction studies in upper limbs of patients with cervical spondylosis and motor neurone disease. Acta Neurol Scand 1988; 78:45-48. Criteria Met (2/6: 1,2) Only nerve conduction studies were studied.
55. Tsai CP, Huang CI, Wang V, Lin KP, Liao KK, Yen DJ, Wu ZA: Evaluation of cervical radiculopathy by cervical root stimulation. Electromyogr Clin Neurophysiol 1994; 34:363-366. Criteria Met (4/6: 1,2,3,6) Thirty-two patients with clinical evidence of unilateral cervical radiculopathy were included. Cervical root stimulation was more sensitive (78.1%) than needle EMG examination (56.2%). See text.
56. Waylonis GW: Electromyographic Findings in Chronic Cervical Radicular Syndromes. Arch Phys Med Rehab 1968; 49:407-412. Criteria Met (3/6: 2,5,6) Needle electromyographic abnormality was seen in 72% of 113 patients with chronic cervical radiculopathy. Fibrillation potentials and/or positive waves were seen in 42%, and polyphasic motor unit potentials were encountered in all patients with abnormal needle EMG. See text.
57. Wilbourn AJ, Aminoff MJ: AAEE minimonograph 32: the electrophysiologic examination in patients with radiculopathies. Muscle Nerve 1998; 21:1612-1631. Background Reference.
58. Yiannikas C, Shahani BT, Young RR: Short-Latency Somatosensory-Evoked Potentials from Radial, Median, Ulnar, and Peroneal Nerve Stimulation in the Assessment of Cervical Spondylosis. Comparison With Conventional Electromyography. Arch Neurol 1986; 43:1264-1271. Criteria Met (4/6: 1,2,3,6) Needle EMG was normal in all 10 patients with only pain and no objective sign of cervical radiculopathy, whereas it was abnormal in 9 of 10 patients with signs of root compression. The sensitivity of needle EMG was better than those of SEP and F wave. See text.
59. Yu YL, Jones SJ: Somatosensory evoked potentials in cervical spondylosis. Correlation of median, ulnar and posterior tibial nerve responses with clinical and radiological findings. Brain 1985; 108:273-300. Criteria Met (2/6: 1,2) Among the 34 patients studied, 15 had myelopathy alone, 6 had radiculopathy, and another 6 had combined radiculopathy and myelopathy. SEP abnormalities correlated strongly with myelopathy but not with radiculopathy.