Lumbar spinal stenosis: Assessment of cauda equina involvement by electrophysiological recordings

Abstract

Whereas the clinical examination, even in severe LSS, showed no specific sensory-motor deficit, the electrophysiological recordings indicated that the majority of patients had a neurogenic disorder within the lumbar spine. By the pattern of bilateral pathological tibial SSEP and pathological reflexes associated with normal peripheral nerve conduction, LSS can be separated from a demyelinating polyneuropathy and mono-radiculopathy. The applied electrophysiological recordings, especially SSEP, can confirm a neurogenic claudication due to cauda equina involvement and help to differentiate neurogenic from vascular claudication or musculo-skeletal disorders of the lower limbs. Therefore, electro-physiological recordings provide additional information to the neurological examination when the clinical relevance of a radiologically-suspected LSS needs to be confirmed.

Clinical value of motor evoked potentials with transcranial magnetic stimulation in the assessment of lumbar spinal stenosis

“…The VAS was divided into four groups: absent (0-1), moderate (2-4), strong (5-7) and very severe pain or numbness (8)(9)(10). The JOA scores of clinical signs (SLR test, sensory and motor disturbances) and VAS scores for back pain, leg pain and leg numbness are shown in Figs.…”

Diagnostic pitfalls in spine surgery: masqueraders of surgical spine disease

“…24,54 Electromyography may also be helpful in reaching a diagnosis. 17 Ultimately, like several of the conditions described in this review, these conditions may occasionally coexist in the same patient.…”

Leg Weakness in a Patient with Lumbar Stenosis and Adrenal Insufficiency

“…Katz et al 8) reported that the more than 30,000 surgical procedures were performed in United States in 1994 to treat LSS. The rate of diagnosis is growing rapidly because of improvements in diagnostic imaging tools and surgical techniques, and the aging of the population 4) . The cardinal symptom of LSS is neurogenic claudication, defined as pain in the buttocks and legs, and numbness or cramping of one or both legs induced by walking, which is relieved when sitting and bending forward 11) .…”

“…Neurological deficits, such as leg motor weakness and cauda equina syndrome are not common in LSS patients, because neural compression is relieved by positional change 6) . In particular, the LSS symptom of rapidly progressing leg weakness must be distinguished from other causes, such as combined diseases or trauma 4) . In the case presented here, whole spine MRI and EMG/NCV showed LSS at L4-5 and radiculopathy in L4, L5, S1 with mild diabetic neuropathy, respectively.…”

“…The cardinal symptom of LSS is neurogenic claudication, defined as pain in the buttocks and legs, and numbness or cramping of one or both legs induced by walking, which is relieved when sitting and bending forward 11) . However, not all patients present with typical symptoms and clinical symptoms in elderly patients are often confused with symptoms of peripheral neuropathy, musculo-skeletal disease and other medical conditions 4) . The decision to employ surgery must be made with caution in elderly patients with rapidly progressing leg weakness, because this condition rarely occurs in the absence of other combined conditions, and the incidence of combined disease in the elderly patients is high 6,11) .…”