Inal Esra E, Eser Filiz, Aktekin Lale A, Oksüz Ergun, Bodur Hatice
Department of Physical Medicine and Rehabilitation, Nafiz Körez Sincan State Hospital, Ankara, Turkey.
J Back Musculoskelet Rehabil. 2013;26(2):169-73. doi: 10.3233/BMR-2012-00364.
Cervical and lumbar roots may be irritated or compressed due to the pathological conditions such as disc herniations, degenerative foraminal stenosis, trauma and tumors. Electrophysiologic tests are frequently used in conjunction with imaging modalities for evaluation of low back and neck pain radiating to extremities, primarily for the purpose of establishing the presence or absence of a radiculopathy. In this study, we aimed to evalulate the relationship between clinic and electroneuromyographic (ENMG) findings in patients with suspected radiculopathies. Forty one patients with radicular complaints in the upper extremities and 51 patients with radicular complaints in the lower extremities were included in this study. McNemar test and Kappa coefficients between the two methods were applied to each group of patients, in order to test the significance of the difference between the two diagnostic procedures' ability on finding out the pathology. The McNemar test identified a significant difference between the two diagnostic approaches both for cervical and lumbar radiculopathies (p<0.001). The Kappa coefficients between the two methods were determined as 0.08 and 0.07, respectively. This means, efficacy of anamnesis and neurological examination for the prediction of electrodiagnostic tests was found to be limited. Normal neurological examination results in a patient with suspected radiculopathy can not eliminate abnormal electrodiagnostic test results; likewise, abnormal findings in the neurological examination would not mean finding pathologies in the electrodiagnostic tests. For more accurate approach to a patient, neurological examination and electrodiagnostic tests must be used and interpreted together.
由于椎间盘突出、椎间孔狭窄、创伤和肿瘤等病理状况，颈神经根和腰神经根可能会受到刺激或压迫。电生理检查经常与成像方式联合使用，用于评估放射至四肢的腰背痛和颈痛，主要目的是确定是否存在神经根病。在本研究中，我们旨在评估疑似神经根病患者的临床症状与神经肌电图（ENMG）检查结果之间的关系。本研究纳入了41例上肢有神经根症状的患者和51例下肢有神经根症状的患者。对每组患者应用两种方法之间的McNemar检验和Kappa系数，以检验两种诊断方法在发现病变方面的差异是否具有显著性。McNemar检验确定，对于颈神经根病和腰神经根病，两种诊断方法之间均存在显著差异（p<0.001）。两种方法之间的Kappa系数分别确定为0.08和0.07。这意味着，发现病史和进行神经学检查对预测电诊断检查结果的有效性有限。疑似神经根病患者的神经学检查结果正常并不能排除电诊断检查结果异常；同样，神经学检查中的异常发现并不意味着电诊断检查中存在病变。为了更准确地诊断患者，必须同时使用和解读神经学检查和电诊断检查。
