Correlation of Electrodiagnostic Findings in C8 Radiculopathies With Radiographic Data: A Retrospective Chart Review.

ABSTRACT: Signs and symptoms of a C8 radiculopathy could mimic common comorbidities such as entrapment and peripheral neuropathies. These conditions and a C8 radiculopathy both can result in abnormal findings on needle examination of intrinsic hand muscles. It was hypothesized that needle examination of C8-innervated muscles in the forearm might improve concordance with magnetic resonance imaging (MRI) in the presence of underlying comorbidities. A retrospective analysis of electromyogram and C-spine MRI data in 80 patients with negative MRI of C-spine for C8-T1 neuroforaminal stenosis was performed. The percentage of false-positive results in the MRI-negative group undergoing electromyogram testing for hand and forearm muscles (MRI-NH + F) was 3% compared with 18% (P = 0.06) in the group with electromyogram of the hand intrinsic muscles only (MRI-NH). The false-positive result tends to be lower in the MRI-NH + F group in comparison with the MRI-NH group especially in the presence of underlying peripheral and entrapment neuropathies.

Identifying biopsychosocial factors that impact decompressive laminectomy outcomes in veterans with lumbar spinal stenosis: a prospective cohort study.

ABSTRACT: One in 3 patients with lumbar spinal stenosis undergoing decompressive laminectomy (DL) to alleviate neurogenic claudication do not experience substantial improvement. This prospective cohort study conducted in 193 Veterans aimed to identify key spinal and extraspinal factors that may contribute to a favorable DL outcome. Biopsychosocial factors evaluated pre-DL and 1 year post-DL were hip osteoarthritis, imaging-rated severity of spinal stenosis, scoliosis/kyphosis, leg length discrepancy, comorbidity, fibromyalgia, depression, anxiety, pain coping, social support, pain self-efficacy, sleep, opioid and nonopioid pain medications, smoking, and other substance use. The Brigham Spinal Stenosis (BSS) questionnaire was the main outcome. Brigham Spinal Stenosis scales (symptom severity, physical function [PF], and satisfaction [SAT]) were dichotomized as SAT < 2.42, symptom severity improvement ≥ 0.46, and PF improvement ≥ 0.42, and analyzed using logistic regression. Sixty-two percent improved in 2 of 3 BSS scales (ie, success). Baseline characteristics associated with an increased odds of success were-worse BSS PF (odds ratio [OR] 1.24 [1.08-1.42]), greater self-efficacy for PF (OR 1.30 [1.08-1.58]), lower self-efficacy for pain management (OR 0.80 [0.68-0.94]), less apparent leg length discrepancy (OR 0.71 [0.56-0.91]), greater self-reported alcohol problems (OR 1.53 [1.07-2.18]), greater treatment credibility (OR 1.31 [1.07-1.59]), and moderate or severe magnetic resonance imaging-identified central canal stenosis (OR 3.52 [1.06-11.6]) moderate, OR 5.76 [1.83-18.1] severe). Using opioids was associated with lower odds of significant functional improvement (OR 0.46 [0.23-0.93]). All P < 0.05. Key modifiable factors associated with DL success-self-efficacy, apparent leg length inequality, and opioids-require further investigation and evaluation of the impact of their treatment on DL outcomes.