A prospective, masked 18-month minimum follow-up on neurophysiologic changes in persons with spinal stenosis, low back pain, and no symptoms

Electrophysiological Characteristics of Cervical Spinal Stenosis

Objective

To investigate electrophysiological characteristics of patients with cervical spinal stenosis (CSS) due to cervical disc herniation.

Methods

A total of 51 patients with CSS diagnosed in our hospital from January 2018 to March 2020 were selected. According to magnetic resonance imaging (MRI), the degree of spinal cord compression was divided into 1-3 grades, namely, group A (MRI grade 1), group B (MRI grade 2), and group C (MRI grade 3), with 17 cases in each group. Subsequently, we analyzed the correlation of the degree of spinal cord compression with the general information, clinical data, and electromyography (EMG) of patients.

Results

Compared with group A and group B, group C had the longest disease course [(48.06 ± 17.71) months], the lowest JOA score (4.59 ± 2.15), and the highest number of positive results of EMG (EMG: A/B/C, 25/51/77); there were significant differences among the 3 groups. And group C had the higher number of positive cases of both upper and lower limbs in SEP test compared with the other two groups (SEP: A/B/C: 12/18/29: χ 2 = 7.559, P = 0.023). According to correlation analysis, MRI grading had no association with gender, age, and spinal canal diameter/volume but was positively correlated with disease course and negatively correlated with JOA score.

Conclusion

This study primarily verifies that higher MRI grade of CSS is associated with longer disease duration and lower JOA score and EMG. The obtained results secondarily demonstrate the correlation between abnormal neurological status and the MRI grade.

Paraspinal muscle denervation and balance impairment in lumbar spinal stenosis

INTRODUCTION

Denervation of the paraspinal muscles may impair posture and displace the center of gravity. Therefore, we assessed balance impairment in patients with lumbar spinal stenosis (LSS) with and without paraspinal denervation.

METHODS

Thirty-two women with LSS (15 symptomatic, 17 asymptomatic), aged 42-78 years, were assessed for disability, pain, and mobility, and underwent masked mini-paraspinal mapping (mPSM). Berg Balance Scale (BBS) and device-assisted balance (DAB) tests were used for balance assessment.

RESULTS

The symptomatic group had worse balance and higher mPSM scores than the asymptomatic group. Among DAB tests, limit of stability (LOS) had the highest correlations with BBS and mPSM in the symptomatic group.

CONCLUSIONS

Paraspinal denervation correlated highly with static and dynamic balance in symptomatic patients. We recommend paraspinal mapping, balance assessment, rehabilitation, and follow-up with the LOS test for symptomatic patients.

Symmetry of paraspinal muscle denervation in clinical lumbar spinal stenosis: support for a hypothesis of posterior primary ramus stretching?

INTRODUCTION

Denervation of the paraspinal muscles in spinal disorders is frequently attributed to radiculopathy. Therefore, patients with lumbar spinal stenosis causing asymmetrical symptoms should have asymmetrical paraspinal denervation.

METHODS

Seventy-three patients with clinical lumbar spinal stenosis, aged 55-85 years, completed a pain drawing and underwent masked electrodiagnostic testing, including bilateral paraspinal mapping and testing of 6 muscles on the most symptomatic (or randomly chosen) limb.

RESULTS

With the exception of 10 subjects with unilateral thigh pain (P = 0.043), there was no relationship between side of pain and paraspinal mapping score for any subgroups (symmetrical pain, pain into 1 calf only). Among those with positive limb EMG (tested on 1 side), no relationship between side of pain and paraspinal EMG score was found.

CONCLUSION

Evidence suggests that paraspinal denervation in spinal stenosis may not be due to radiculopathy, but rather due to stretch or damage to the posterior primary ramus.