Electrophysiological Diagnostic Certainty in Spinal Nerve Root Entrapment

Abstract

Objective: Evaluation of sensitivity of different electrophysiological parameters among Egyptians with clinically spinal nerve entrapment. Methods: 100 spinal nerve entrapment patients and 41 healthy control. Exclusion; diabetes mellitus, renal, hepatic, endocrine disorder, other nerve involvements. Patients subjected to: Demographic data, detailed neurological history, examination. EDX; NCS, H-reflex, F-wave, Dermatomal Sensory Evoked Potential (DSEP), EMG. Normal cervical DSEP latency and same side Inter-root latency difference was calculated. Values more than 1.57 were considered abnormal. Results: Mean age 49.6 ± 10.6. sensory pattern 87%, motor pattern 9%, sensorimotor patterns 4%. Single nerve root (56%), highest C7 root (25%) (.44%. Multiple nerve root; highest C6,C7 (20.5%). No significant pattern difference among single versus multiple roots. Among single root: 91.9% sensory, 6.9% motor, 1.7% sensorimotor. Within multiple roots; sensory (81.8%), motor (11.4%), sensorimotor 6.8%. Positive DSEP; 98.2% sensory and all motor/sensoriomotor, all cervical and 93.8% lumbosacral patients. Cervical Latency normal/pathological: C5 l 18.68 ± 3.5/27.84 ± 4.02. C6: 22.18 ± 1.6)/26.38 ± 2.8. C7; 21.01 ± 1.8./25.6 ± 2.04. C8: 21.93 ± 1.7/5.93 ± 2.5. Significant difference between normal vs pathological latency. Positive F-wave; 57.5% sensory, 80%motor, 83.3%, sensorimotor. Abnormal H-reflex in patients with S1 root manifestations. Abnormal EMG: motor, sensorimotor and 54.2% sensory patterns. Conclusion: Commonest presentation is sensory. H-reflex is highly sensitive among S1 patients. DSEP is highly sensitive among sensory patterns. Sensitivity of F-wave is low among sensory, higher with motor/sensorimotor, with two segments accuracy. EMG is highly sensitive in motor but less with sensory pattern.