Archives of Physical Medicine and Rehabilitation
Volume 87, Issue 7 , Pages 897-903, July 2006

Spinal Stenosis, Back Pain, or No Symptoms at All? A Masked Study Comparing Radiologic and Electrodiagnostic Diagnoses to the Clinical Impression

  • Andrew J. Haig, MD

      Affiliations

    • Spine Program, Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI.
    • Corresponding Author InformationCorrespondence to Andrew J. Haig, MD, Dept of Physical Medicine and Rehabilitation, University of Michigan, 325 E Eisenhower, Ann Arbor, MI 48108
    • ,
  • Henry C. Tong, MD, MS

      Affiliations

    • Spine Program, Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI.
    • ,
  • Karen S. Yamakawa, MS

      Affiliations

    • Spine Program, Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI.
    • ,
  • Douglas J. Quint, MD

      Affiliations

    • Department of Radiology, University of Michigan, Ann Arbor, MI.
    • ,
  • Julian T. Hoff, MD

      Affiliations

    • Department of Neurosurgery, University of Michigan, Ann Arbor, MI.
    • ,
  • Anthony Chiodo, MD

      Affiliations

    • Spine Program, Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI.
    • ,
  • Jennifer A. Miner, MBA

      Affiliations

    • Spine Program, Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI.
    • ,
  • Vaishali R. Choksi, MD

      Affiliations

    • Department of Radiology, University of Michigan, Ann Arbor, MI.
    • ,
  • Michael E. Geisser, PhD

      Affiliations

    • Spine Program, Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI.
    • ,
  • Christopher M. Parres, BS

      Affiliations

    • Spine Program, Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI.

Abstract 

Haig AJ, Tong HC, Yamakawa KS, Quint DJ, Hoff JT, Chiodo A, Miner JA, Choksi VR, Geisser ME, Parres CM. Spinal stenosis, back pain, or no symptoms at all? A masked study comparing radiologic and electrodiagnostic diagnoses to the clinical impression.

Objective

To assess the relations between clinically recognized lumbar spinal stenosis and the conclusions of masked radiologists and electrodiagnosticians.

Design

Prospective, masked, double-controlled trial.

Setting

University spine center.

Participants

One hundred fifty persons age 55 to 80 years with or without back pain and with or without magnetic resonance imaging (MRI)–demonstrated stenosis, screened for neuropathy risk, previous surgery, or cancer.

Interventions

Questionnaires on pain and function; ambulation testing and physical examination; and masked electrodiagnotics and MRI.

Main Outcome Measure

Diagnostic impressions of the examining clinician, radiologist, and electrodiagnostician.

Results

Following application of post hoc exclusion criteria and elimination of patients due to incomplete or inadequate test data, the clinical diagnosis was lumbar stenosis in 50 subjects, back pain in 44 subjects, and no pain in 32 subjects. Radiologic and clinical impression had no relation (P=.80 vs asymptomatic, P=.99 vs back pain controls). Electrodiagnostic impression trended to relate to clinical impression (P=.14 vs asymptomatic, P=.09 vs back pain). Retrospective application of age-related electrodiagnostic norms for paraspinal electromyographic and limb motor unit changes, established in this study, reclassified 13 of the 17 asymptomatic persons whom the electrodiagnostician thought had stenosis. The clinical impression did correspond to history and physical examination findings typically associated with spinal stenosis and to the independent impression of a neurosurgeon who examined MRI and clinical, but not to the electrodiagnostic data.

Conclusions

The impression obtained from an MRI scan does not determine whether lumbar stenosis is a cause of pain. Electrodiagnostic consultation may be useful, especially if age-related norms obtained in this study are applied.

Key Words:  Back pain , Electrodiagnosis , Magnetic resonance imaging , Referral and consultation , Rehabilitation , Spinal stenosis

 

 Supported by the National Institutes of Health (grant no. 5 R01 NS41855-02). The opinions contained in this publication are those of the grantee and do not necessarily reflect those of the U.S. Department of Health and Human Services. The funding source had no role in any of the following: the design and conduct of the study; collection, management, analysis, and interpretation of the data; and preparation, review, or approval of the manuscript.No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit upon the author(s) or upon any organization with which the author(s) is/are associated.

PII: S0003-9993(06)00316-9

doi:10.1016/j.apmr.2006.03.016

Archives of Physical Medicine and Rehabilitation
Volume 87, Issue 7 , Pages 897-903, July 2006

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