J Korean Orthop Assoc.  2010 Oct;45(5):386-391.

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

• Park BJ
• Choi BW
• Song KJ
• Park C

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.

Keyword

cervical; multilevel radiculopathy; diagnosis; usefulness

MeSH Terms

Diagnostic Tests, Routine
Humans
Physical Examination
Radiculopathy
Sensitivity and Specificity

Figure

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  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 4th and 5th 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.

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