Skip to main content
Egyptian Rheumatology and Rehabilitation
Download PDF

Electromyographic study to predict functional outcome of transforaminal epidural steroid injection in lumbosacral radiculopathy

Egyptian Rheumatology and Rehabilitation volume 46, pages 27–34 (2019)Cite this article

Abstract

Context

Epidural steriod injections (ESIs) are commonly used for managment of lumbosacral radiculopathy (LSR). Predicting outcomes after ESIs could be another valuable application of needle electromyography (EMG) in these patients.

Aim

The aim was to determine if EMG study can predict the functional outcome of transforaminal ESIs in patients with LSR.

Materials and methods

The study included 20 patients with clinical diagnosis of LSR. Peripheral nerve conduction study, late responses, somatomsensory evoked potentials, and needle EMG were performed in both lower limbs followed by transforaminal ESI under fluoroscopic guidance. The functional outcome was evaluated using visual analog scale for pain and Oswestry disability index (ODI) that were performed before and after injections.

Results

There were statistically significant decrease in pain severity (visual analog scale; P=0.022) and in ODI (improvement in functional score; P=0.029) after injection in patients with symptom duration less than 3 months compared with patients with longer duration of symptoms. In patients with negative EMG findings, there was a significantly greater reduction in pain severity (P <0.01) and ODI score (P <0.01) after injection compared with patients with positive findings. Regression analysis showed that negative needle EMG findings were significant predictors of pain reduction (P=0.001) and functional improvement (P=0.002) in patients with LSR after ESI.

Conclusion

This study supports the notion that EMG studies can be used for prediction of functional outcome in patients with LSR performing transforaminal ESI.

References

  1. Liang H, Katz N. Clinical evaluation of patients with a suspected spine problem. In: Frymoyer W, editor. The adult spine: principles and practice. New York: Raven 1991. 223–239

    Google Scholar 

  2. Annaswamy M, Bierner M, Chouteau L. Needle electromyography predicts outcome after lumbar epidural steroid injection. Muscle Nerve 2012; 45:346–355

    Article  Google Scholar 

  3. Deyo RA, Diehl AK. Cancer as a cause of back pain: frequency, clinical presentation, and diagnostic strategies. J Gen Intern Med 1988; 3:230–238

    Article  CAS  Google Scholar 

  4. Karen B. Electrodiagnosis of lumbar radiculopathy. Phys Med Rehabil Clin N Am 2013; 24:79–80

    Article  Google Scholar 

  5. Mills R. The basics of electromyography. J Neurol Neurosurg Psychiatry 2005; 76:32–35

    Google Scholar 

  6. Braune J, Wunderlich T. Diagnostic value of different neurophysiological methods in the assessment of lumbar nerve root lesions. Arch Phys Med Rehabil 1997; 78:518–520

    Article  CAS  Google Scholar 

  7. Lutz E, Vad B, Wisneski J. Fluoroscopic transforaminal lumbar epidural steroids: an outcome study. Arch Phys Med Rehabil 1998; 79:1362-1366

    Article  CAS  Google Scholar 

  8. Singh V, Manchikanti L. Role of caudal epidural injections in the management of chronic low back pain. Pain Physician 2002; 5:133–148

    PubMed  Google Scholar 

  9. Artuso JA. Back pain and needles: epidural steroid injections for radicular back pain. J Lancaster General Hosp 2007; 2:95–100

    Google Scholar 

  10. Abdi S, Datta S, Trescot AM, Schultz DM, Adlaka R, Atluri SL, et al. Epidural steroids in the mamagment of chronic spinal pain: a systematic review. Pain Physician 2007; 10:185–212

    PubMed  Google Scholar 

  11. Schaufele MK, Hatch L, Jones W. Interlaminar versus transforaminal epidural injections for the treatment of symptomatic lumbar intervertebral disc herniations. Pain Physician 2006; 9:361–366

    PubMed  Google Scholar 

  12. Riew KD, Yin Y, Gilula L, Bridwell KH, Lenke LG, Lauryssen C, Goette K. The effect of nerve root injections on the need for operative treatment of lumbar radicular pain. A prospective, randomized, controlled, double-blind study. J Bone Joint Surg Am 2000; 82:1589–1593

    CAS  PubMed  Google Scholar 

  13. Smith C, Booker T, Schaufele K. Interlaminar versus transforaminal epidural steroid injections for the treatment of symptomatic lumbar spinal stenosis. Pain Med 2010; 11:1511–1515

    Article  Google Scholar 

  14. Chouteau W, Bierner M, Annaswamy M. Predictive value of electromyography of response to lumbar epidural steroid injections in patients with lumbar radiculopathy. Am J Phys Med Rehab 2009; 88:S6

    Google Scholar 

  15. Bierner M, Annaswamy M, Chouteau L. Predictive value of electromyography for response to epidural steroid injection in patients with lumbar radiculopathy. Muscle Nerve 2009; 40:710

    Google Scholar 

  16. Fish E, Shirazi P, Pham Q. The use of electromyography to predict functional outcome following transforaminal epidural spinal injections for lumbar radiculopathy. J Pain 2008; 9:64–70

    Article  Google Scholar 

  17. Tong C, Williams C, Haig J, Geisser ME, Chiodo A. Predicting outcomes of transforaminal epidural injections for sciatica. Spine J 2003; 3:430–434

    Article  Google Scholar 

  18. Cho SC, Ferrante MA, Levin KH, Harmon RL, So YT. Utility of electrodiagnostic testing in evaluating patients with lumbosacral radiculopathy: an evidence-based review. Muscle Nerve 2010; 42:276–282

    Article  Google Scholar 

  19. Kirkadly-Willis WH, Yong-Hing K. Lateral recess, lateral canal, and foraminal stenosis. In: Watkins RG, Collis JS, editors. Lumbar discectomy and laminectomy. Rockville: Aspen Publishers Inc; 1987. 245–252

    Google Scholar 

  20. Preston C, Shapiro E, editor. Electromyography and neuromuscular disorders: clinical-electrophysiologic correlations. 3rd ed. China: Elsevier; 2013

    Google Scholar 

  21. Wewer ME, Lowee NK. A critical review of visual analogue scale in the measurement of clinical phenomena. Res Nur Health 1990; 13:227–236

    Article  Google Scholar 

  22. Fairbank JCT, Couper J, Davies JB. The Oswestry low Back Pain Questionnaire. Physiotherapy 1980; 66: 271–273

    CAS  PubMed  Google Scholar 

  23. Boduk N, Aprill C, Derby R. Epidural steroid injection. In: White AH, editor. Spine care. Vol. 1. St. Louis: Mosby 1995. 322–343

    Google Scholar 

  24. Botwin KP, Gruber RD, Bouchlas CG, Torres-Ramos FM, Sanelli JT, Freeman ED, et al. Fluoroscopically guided lumbar transformational epidural steroid injections in degenerative lumbar stenosis: an outcome study. Am J Phys Med Rehabil 2002; 81:898–905

    Article  Google Scholar 

  25. Ng L, Chaudhary N, Sell P. The efficacy of corticosteroids in periradicular infiltration for chronic radicular pain: a randomized, double-blind, controlled trial. Spine (Phila Pa 1976) 2005; 30:857–862

    Article  Google Scholar 

  26. Lee KS, Lin CL, Hwang SL, Howng SL, Wang CK. Transforaminal periradicular infiltration guided by CT for unilateral sciatica – an outcome study. Clin Imaging 2005; 29:211–214

    Article  Google Scholar 

  27. Karppinen J, Malmivaara A, Kurunlahti M, Kyllönen E, Pienimäki T, Nieminen P, et al. Periradicular infiltration for sciatica: a randomized controlled trial. Spine (Phila Pa 1976) 2001; 26:1059–1067

    Article  CAS  Google Scholar 

  28. McCormick Z, Cushman D, Caldwell M, Marshall B, Ghannad L, Eng C, et at. Does electrodiagnostic confirmation of radiculopathy predict pain reduction after transforaminal epidural steroid injection? A multicenter study. J Nat Sci 2015; 1:e140

    PubMed  PubMed Central  Google Scholar 

  29. Cyteval C, Fescquet N, Thomas E, Decoux E, Blotman F, Taourel P. Predictive factors of efficacy of periradicular corticosteroid injections for lumbar radiculopathy. AJNR Am J Neuroradiol 2006; 27:978–982

    CAS  PubMed  Google Scholar 

  30. Cooper G, Lutz GE, Boachie-Adjei O, Lin J. Effectiveness of transforaminal epidural steroid injections in patients with degenerative lumbar scoliotic stenosis and radiculopathy. Pain Physician 2004; 7:311–317

    PubMed  Google Scholar 

  31. Vad VB, Bhat AL, Lutz GE, Cammisa F. Transforaminal epidural steroid injections in lumbosacral radiculopathy: a prospective randomized study. Spine (PhilaPa 1976) 2002; 27:11–16

    Article  Google Scholar 

  32. Cosgrove JL, Bertolet M, Chase SL, Cosgrove GK. Epidural steroid injections in the treatment of lumbar spinal stenosis efficacy and predictability of successful response. Am J Phys Med Rehabil 2011; 90:1050–1055

    Article  Google Scholar 

  33. Marchetti J, Verma-Kurvari S, Patel N, Ohnmeiss DD. Are electrodiagnostic study findings related to a patient’s response to epidural steroid injection? PM R 2010; 2:1016–1020

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Physical Medicine, Rheumatology and Rehabilitation, Faculty of Medicine, Alexandria University, Alexandria, Egypt

    Hussein Sultan, Wafaa S. El-Emary (MD) & Shehad M. Fakhry

  2. Department of Neurosurgery, Faculty of Medicine, Alexandria University, Alexandria, Egypt

    Tamer H. Shehata

Authors
  1. Hussein Sultan
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Tamer H. Shehata
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Wafaa S. El-Emary
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Shehad M. Fakhry
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Wafaa S. El-Emary.

Additional information

This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.

Rights and permissions

This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Sultan, H., Shehata, T.H., El-Emary, W.S. et al. Electromyographic study to predict functional outcome of transforaminal epidural steroid injection in lumbosacral radiculopathy. Egypt Rheumatol Rehabil 46, 27–34 (2019). https://doi.org/10.4103/err.err_6_18

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.4103/err.err_6_18

Keywords

  • disability index
  • electromyography
  • epidural injection
  • functional outcome
  • lumbosacral radiculopathy
  • pain
  • transforaminal