Publication: Lomber spinal dar kanal tanılı hastalarda paraspinal haritalama yönteminin radyolojik ve klinik bulgularla ilişkisi
Abstract
Bu çalışmanın amacı lomber spinal dar kanal (LSDK) tanısında bir elektrofizyolojik teknik olan paraspinal haritalama (PSH) yönteminin, görüntüleme ve klinik bulgular ile ilişkisinin incelenmesidir. Çalışmaya Marmara Üniversitesi Fiziksel Tıp ve Rehabilitasyon Polikliniği’ne başvuran 60 hasta alındı. Hastalar deneyimli bir klinisyen tarafından değerlendirilerek klinik ve görüntüleme bulgularına göre klinik ve radyolojik LSDK, radyolojik LSDK ve kontrol olmak üzere 3 gruba ayrıldı. Hastaların lomber spinal manyetik rezonans görüntüleme (MRG) bulguları klinik bulgulardan habersiz bir radyolog tarafından değerlendirildi. Klinik ve radyolojik değerlendirmeyi bilmeyen bir elektrofizyolog tarafından sinir iletim çalışmaları, alt ekstremitelere yönelik iğne elektromiyografi (EMG) ve PSH yöntemleri uygulandı. İki hasta polinöropati saptanması nedeni ile çalışma dışı kaldı. Elde edilen klinik, görüntüleme ve elektrofizyolojik veriler karşılaştırılarak PSH’nın LSDK tanısındaki etkinliği araştırıldı. Klinik ve radyolojik LSDK grubunda PSH ile %96.4 hastada LSDK saptandı. Yalnızca bir hastada (%3.6) spontan aktivite bulguları yoktu. Ortalama toplam PSH skoru 33.64±21.17 idi. Radyolojik LSDK grubunda ise %93.8 PSH normal olarak değerlendirilirken bir hastada spontan aktivite bulgusu saptandı. Kontrol grubunda 8 hastanın PSH skoru 0 iken 6 hastanın skoru yüksek (0-9) bulundu. PSH pozitif olan bu hastalarda lomber disk hernisi vardı. PSH yönteminin sensitivitesi 9 ve üstü skorlar için %96.8 bulundu. Klinik ve radyolojik LSDK grubunda ekstremite EMGsinde %50 hastada patolojik spontan aktivite bulguları, %46.4 oranında ise kronik nörojenik tutulum bulguları saptandı. PSH yönteminin semptomatik hastalarda ekstremite EMG’sine göre daha duyarlı olduğu görüldü. Paraspinal haritalama LSDK tanısında sensivitesi yüksek bir yöntemdir ve ekstremite EMG’sine göre sinir köklerinin fizyolojisini daha iyi yansıtmaktadır. lomber spinal dar kanal, paraspinal haritalama, elektromiyografi, manyetik rezonans görüntüleme
Title: The Realationship Of Paraspinal Mapping Technique With Radiological and Clinical Findings In Patients With Lomber Spinal Stenosis The aim of this study is to evaluate the correlation of paraspinal mapping (PSM) which is an electrophysiological technique in diagnosis of lumbar spinal stenosis (LSS) with clinical and radiological findings. Sixty patients who referred to Marmara University Physical Medicine and Rehabilitation Outpatient Clinic were enrolled to study. The patients were assessed by an experienced clinician and divided in to tree groups as follows: clinical and radiological LSS, radiological LSS and control group. The magnetic resonance imaging studies of the patients were assessed by a radiologist who was masked to clinical features. An electromyographer who was also masked to patients’ findings performed nerve conduction tests, lower extremity EMG and PSM. Two patients were dropped out because diagnosed as polyneuropathy. The clinical, radiological and electrophysiological findings were analized to assess the effectiveness of PSM in LSS diagnosis. Electrophysiological LSS was diagnosed 96.4% in clinical and radiological LSS group. There was no pathologic spontaneous activity only in one patient (3.6%). The mean PSM score was 33.64±21.17. In radiological group PSM were normal in 93,8% patients. There was pathologic spontaneous activity only in one patient. In the control group in 6 of 14 patients had high PSM scores (range 0-9). All of these patients were diagnosed as radiculopathy due to disc herniation. In clinical and radiological LSS group extremity EMG were found as 50% acute neurogenic and 46.4% chronic neurogenic. PSM was found more sensitive than extremity EMG in symptomatic patients. PSM technique is sensitive method in diagnosis of LSS and reflects physiology of nevre roots beter than ekstremity EMG Lumbar spinal stenosis, paraspinal mapping, electromyography, magnetic resonance imaging
Title: The Realationship Of Paraspinal Mapping Technique With Radiological and Clinical Findings In Patients With Lomber Spinal Stenosis The aim of this study is to evaluate the correlation of paraspinal mapping (PSM) which is an electrophysiological technique in diagnosis of lumbar spinal stenosis (LSS) with clinical and radiological findings. Sixty patients who referred to Marmara University Physical Medicine and Rehabilitation Outpatient Clinic were enrolled to study. The patients were assessed by an experienced clinician and divided in to tree groups as follows: clinical and radiological LSS, radiological LSS and control group. The magnetic resonance imaging studies of the patients were assessed by a radiologist who was masked to clinical features. An electromyographer who was also masked to patients’ findings performed nerve conduction tests, lower extremity EMG and PSM. Two patients were dropped out because diagnosed as polyneuropathy. The clinical, radiological and electrophysiological findings were analized to assess the effectiveness of PSM in LSS diagnosis. Electrophysiological LSS was diagnosed 96.4% in clinical and radiological LSS group. There was no pathologic spontaneous activity only in one patient (3.6%). The mean PSM score was 33.64±21.17. In radiological group PSM were normal in 93,8% patients. There was pathologic spontaneous activity only in one patient. In the control group in 6 of 14 patients had high PSM scores (range 0-9). All of these patients were diagnosed as radiculopathy due to disc herniation. In clinical and radiological LSS group extremity EMG were found as 50% acute neurogenic and 46.4% chronic neurogenic. PSM was found more sensitive than extremity EMG in symptomatic patients. PSM technique is sensitive method in diagnosis of LSS and reflects physiology of nevre roots beter than ekstremity EMG Lumbar spinal stenosis, paraspinal mapping, electromyography, magnetic resonance imaging