Usefulness of Diagnostic Tools in Determining the Operation Level in Multi-level Cervical Radiculopathy: Comparison between Physical Findings, MRI, and EMG

Bong-Ju Park; Byung-Wan Choi; Kyung-Jin Song; Cheol Park

doi:10.4055/jkoa.2010.45.5.386

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Park, Choi, Song, and Park: Usefulness of Diagnostic Tools in Determining the Operation Level in Multi-level Cervical Radiculopathy: Comparison between Physical Findings, MRI, and EMG

Original Article

Journal of the Korean Orthopaedic Association

Journal of the Korean Orthopaedic Association 2010; 45(5): 386-391.

Published online: 31 October 2010

DOI: https://doi.org/10.4055/jkoa.2010.45.5.386

Usefulness of Diagnostic Tools in Determining the Operation Level in Multi-level Cervical Radiculopathy: Comparison between Physical Findings, MRI, and EMG

Bong-Ju Park, M.D., Byung-Wan Choi, M.D., Kyung-Jin Song, M.D.^*, Cheol Park, M.D.

Department of Orthopedic Surgery, Gwang-ju Veterans Hospital, Gwangju, Korea.

^*Institute for Medical Sciences, Chonbuk National University College of Medicine, Chonju, Korea.

Correspondence to: Byung-Wan Choi, M.D. Department of Orthopedic Surgery, Gwang-Ju Veterans Hospital, Sanwol-dong, 887-1, Gwangsan-gu, Gwangju 506-705, Korea. TEL: +82-62-602-6162, FAX: +82-62-602-6989, alla1013@naver.com

Received 9 November 2009 Accepted 9 August 2010

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

The purpose of this study was to verify the usefulness of each diagnostic tool by comparing physical examination, MRI, and EMG findings with operative findings in multilevel cervical radiculopathy.

Materials and Methods

Thirty-six (n=36) multilevel cervical radiculopathy patients with a total of 180 levels were included in this study. The findings of preoperative diagnostic tests, including physical examination, EMG and MRI, were analyzed for sensitivity, specificity, positive predictive value and negative predictive value by comparing with the operative findings, which was regarded as the gold standard. Correlation between each diagnostic tools were also analyzed.

Results

The sensitivity, specificity, positive and negative predictive values of each item in sensory deficiency were 37%, 86%, 60%, and 72%, motor weakness 62%, 88%, 78%, and 78%, EMG 47%, 87%, 70%, and 71%, and MRI 91%, 86%, 81%, and 93% respectively. Each element showed statistically significant correlation with each diagnostic modality. Correlation between the operative findings and MRI was highest, at 0.766.

Conclusion

MRI was the most useful diagnostic modality in multi-level cervical radiculopathy. EMG showed relatively low sensitivity and should be considered in conjunction with its clinical application.

Keywords: cervical, multilevel radiculopathy, diagnosis, usefulness

Figures and Tables

Figure 1

A 64-year-old female visited due to the neck discomfort and left upper extremity radiating pain. Pre-operative physical examination showed left 4^th and 5^th finger tingling sensation and motor weakness of grade 4 in left wrist flexor and finger flexion. EMG showed no detectable abnormality. (A) Preoperative MRI. The levels of C3-4, 5-6 and C7-T1 were regarded as positive. (B) Anterior cervical disectomy and fusion of C7-T1 were performed. In the operative finding, left C8 nerve root was compressed by left uncovertebral joint hypertrophy.

Table 1

The Number of Segments Showing Abnormal Finding

EMG, Electromyography; MRI, Magnetic resonance imaging.

Table 2

The Number of Cases Classified by the Number of Abnormal Segments

Table 3

Validity of Each Diagnostic Method

Table 4

Pearson Correlation Ratio and p-value of Each Diagnostic Methods

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