Radikülopati ve Pleksopatilerde Elektrodiagnostik Testler
Özet
Elektrodiagnostik testler, radikülopati ve pleksopatilerin tanısında, ayırıcı tanısında, prognozunun ve lokalizasyonunun belirlenmesinde büyük öneme sahiptir. Duyu sinir iletim çalışmaları, periferik sinir lezyonu yoksa radikülopatide normal beklenirken, pleksopatilerde anormallik gösterir. Benzer şekilde motor sinir iletimleri ve F-dalga yanıtları da tanı sürecinde değerlendirilir. S1 radikülopatisinde H-refleksi duyarlılığı F-dalgasına göre daha yüksektir. Radikülopati tanısında en önemli elektrodiagnostik yöntem olan iğne EMG'de, kaslarda pozitif keskin dalga, fibrilasyon potansiyelleri ve nörojenik MÜP'ler izlenir. Farklı sinir innervasyonlu ancak aynı kökten beslenen kaslarda ya da paraspinal kaslarda iğne EMG anormalliği saptanması radikülopati tanısını desteklerken; paraspinal anormallikler pleksopatilerde görülmez. İğne EMG'nin şikayetlerden 3 hafta sonra yapılması önerilir. Pleksopatilerde ise aksonal hasara bağlı olarak küçük amplitüdlü bileşik sinir ve kas aksiyon potansiyelleri izlenir ve iğne EMG lezyon lokalizasyonunu belirlemede kritik rol oynar.
Electrodiagnostic tests are of great importance in the diagnosis, differential diagnosis, prognosis, and localization of radiculopathy and plexopathy. Sensory nerve conduction studies are expected to be normal in radiculopathy unless there is a peripheral nerve lesion, whereas abnormalities are expected in plexopathies. Similarly, motor nerve conduction and F-wave responses are evaluated during the diagnostic process. The sensitivity of the H-reflex is higher than the F-wave in S1 radiculopathy. In needle EMG, which is the most critical electrodiagnostic method for radiculopathy diagnosis, positive sharp waves, fibrillation potentials, and neurogenic MUPs are observed in muscles. The presence of needle EMG abnormalities in two muscles innervated by different nerves but the same root, or in paraspinal muscles, strongly supports the diagnosis of radiculopathy, whereas paraspinal abnormalities are not seen in plexopathies. It is recommended to perform needle EMG 3 weeks after the onset of complaints. In plexopathies, small-amplitude compound nerve and muscle action potentials are observed due to axonal damage, and needle EMG plays a critical role in determining the localization of the lesion.
Referanslar
Li JM, Tavee J. Electrodiagnosis of radiculopathy. Handb Clin Neurol 2019; 161:305-316.
Dhawan PS. Electrodiagnostic Assessment of Plexopathies. Neurol Clin 2021; 39(4): 997-1014.
Marquardt RJ, Levin KH. Electrodiagnostic Assessment of Radiculopathies. Neurol Clin 2021;39(4): 983-995.
Levin KH. Approach to the patient with suspected radiculopathy. Neurol Clin 2012; 30(2): 581-604.
Berger AR, Sharma K, Lipton RB. Comparison of motor conduction abnormalities in lumbosacralradiculopathy and axonal polyneuropathy. Muscle Nerve 1999; 22: 1053–1057.
Weber F. The diagnostic sensitivity of different F wave parameters. J Neurol Neurosurg Psychi-atry. 1998; 65(4): 535-540.
Mauricio EA, Dimberg EL, Rubin DI. Utility of minimum F-wave latencies compared with F-esti-mates and absolute reference values in S1 radiculopathies: are they still needed?. Muscle Nerve 2014; 49(6): 809-813.
Cho SC, Ferrante MA, Levin KH, Harmon RL, So YT. Utility of electrodiagnostic testing in evalu-ating patients with lumbosacral radiculopathy: An evidence-based review. Muscle Nerve 2010; 42(2):276-282.
Zheng C, Liang J, Nie C, Zhu Y, Lu F, Jiang J. F-waves of peroneal and tibial nerves in the differentialdiagnosis and follow-up evaluation of L5 and S1 radiculopathies. Eur Spine J 2018;27(8):1734–1743.
Jankus WR, Robinson LR, Little JW. Normal limits of side-to-side H-reflex amplitude variability.Arch Phys Med Rehabil 1994;75:3–6.
Dillingham TR, Annaswamy TM, Plastaras CT. Evaluation of persons with suspected lumbosac-ral and cervical radiculopathy: Electrodiagnostic assessment and implications for treatment and outcomes (Part I). Muscle Nerve 2020; 62(4): 462-473.
Tong HC. Specificity of needle electromyography for lumbar radiculopathy in 55 to 79 yearold subjects with low back pain and sciatica without stenosis. Am J Phys Med Rehabil2011;90(3):233–238.
Spengler DM, Ouellette EA, Battie M, Zeh J. Elective discectomy for herniation of a lumbar disc:additional experience with an objective method. J Bone Joint Surg 1990;72A:230-237.
Spengler DM, Freeman CW. Patient selection for lumbar discectomy. An objective approach. Spine (Phila Pa 1976) 1979;4(2):129-134.
Dillingham TR, Lauder TD, Andary M, Kumar S, Pezzin LE, Stephens RT, Shannon S. Identifying lumbosacral radiculopathies: an optimal electromyographic screen. Am J Phys Med Rehabil 2000; 79(6): 496-503.
Dillingham TR, Dasher KJ. The lumbosacral electromyographic screen: revisiting a classic paper. Clin Neurophysiol 2000; 111(12): 2219-2222.
Tsao B. The electrodiagnosis of cervical and lumbosacral radiculopathy. Neurol Clin 2007; 25(2): 473-494.
Dillingham TR. Evaluating the patient with suspected radiculopathy. PMR 2013; 5(Suppl 5): 41-46.
Nardin RA, Raynor EM, Rutkove SB. Fibrillations in lumbosacral paraspinal muscles of normal subjects. Muscle Nerve 1998; 21: 1347–1349.
Wilbourn A, Aminoff M (1998). AAEM Minimonograph 32: the electrodiagnostic examination in patients with radiculopathies. Muscle Nerve 21: 1612–1631
Kottlors M, Glocker FX. Polysegmental innervation of the medial paraspinal lumbar muscles. Eur Spine J 2008;17:300-306.
Dillingham TR, Annaswamy TM, Plastaras CT. Evaluation of persons with suspected lumbosac- ral and cervical radiculopathy: Electrodiagnostic assessment and implications for treatment and outcomes (Part II). Muscle Nerve 2020; 62(4): 474-484.
Rubin DI. Brachial and lumbosacral plexopatihes: A review. Clin Neurolphysiol Pract 2020; 5:173- 193.
Dillingham TR, Pezzin LE, Lauder TD. Relationship between muscle abnormalities and symptom duration in lumbosacral radiculopathies. Am J Phys Med Rehabil 1998;77:103-107.
Pezzin LE, Dillingham TR, Lauder TD, Andary M, Kumar S, Stephens RT, Shannon S. Cervical radiculopathies: relationship between symptom duration and spontaneous EMG activity. Muscle Nerve 1999;22:1412-1418.
Zambelis T, Piperos P, Karandreas N. Fibrillation potentials in paraspinal muscles in chronic lum bosacral radiculopathy. Acta Neurol Scand 2002;105:314-317.
Savage NJ, Fritz JM, Kircher JC, Thackeray A. The prognostic value of electrodiagnostic testing in patients with sciatica receiving physical therapy. Eur Spine J 2015;24:434-443.
Rigler I, Podnar S. Impact of electromyographic findings on choice of treatment and outcome. Eur J Neurol 2007;14(7):783-787.
Nicotra A, Khalil NM, O’Neill K. Cervical radiculopathy: discrepancy or concordance between ele- ctromyography and magnetic resonance imaging? Br J Neurosurg 2011;25(6):789-790.
Barr K. Electrodiagnosis of lumbar radiculopathy. Phys Med Rehabil Clin N Am 2013; 24(1): 79- 91.
Kouyoumdjian JA, Ronchi LG, de Faria FO. Jitter evaluation in denervation and reinnervation in 32 cases of chronic radiculopathy. Clin Neurophysiol Pract 2020;5:165–72.
Sunderland S. A classification of peripheral nerve injuries producing loss of function. Brain 1951; 74(4):491-516.
Seddon HJ. A Classification of Nerve Injuries. Br Med J 1942; 2(4260): 237-239.
Strakowski JA. Electrodiagnosis of plexopathy. PMR 2013; 5(Suppl 5): 50-55.
Fisher MA. F-wave studies: Clinical utility. Muscle Nerve 1998;21: 1098-1101.
Young RR, Shahani BT. Clinical value and limitations of F-wave determination. Muscle Nerve 1978;1:248-249.
Eisen A, Hoirch M. Electrodiagnostic evaluation of radiculopathies and plexopathies using so- matosensory evoked potentials. Electroencephalogr Clin Neurophysiol 1982;36(Suppl):349-357.
Pitt M, Vredeveld JW. The role of electromyography in the management of the brachial plexus palsy of the newborn. Clin. Neurophys 2005; 116 (8): 1756–1761.
Harper CM, Thomas JE, Cascino TL, Litchy WJ. Distinction between neoplastic and radiation-in- duced brachial plexopathy, with emphasis on the role of EMG. Neurology 1989; 39 (4): 502–506.
Impastato DM, Impastato KA, Dabestani P, et al. Prognostic value of needle electromyography in traumatic brachial plexus injury. Muscle Nerve 2019;60(5): 595–597.
Heise CO, Siqueira MG, Martins RS, Gherpelli JLD. Clinical electromyography correlation in in fants with obstetric brachial plexopathy. J Hand Surg 2007; 32 (7): 999–1004.
Sherburn EW, Kaplan SS, Kaufman BA, Noetzel M J, Park TS. Outcome of surgically treated birth-related brachial plexus injuries in twenty cases. Pediatr Neurosurg 1997; 27 (1): 19–27.
