Session Title: Research Spotlight: Pain and Spine Medicine
Session Time: None. Available on demand.
Disclosures: Melissa E. Phuphanich, MD, MS: No financial relationships or conflicts of interest
Objective: There is minimal existing research that identifies patients with cervical radicular pain who would benefit most from epidural steroid injections (ESIs). The role that electromyography (EMG) plays in diagnostic confirmation of radiculopathy is well-established, and there is literature to suggest a strong prognostic role for EMGs in predicting outcomes after lumbar ESI for lumbosacral radiculopathies. However, the prognostic value of confirming cervical radiculopathy with EMG prior to ESI is not yet well-defined. The objective of this study is to determine if EMG confirmation of cervical radiculopathy predicts improved outcomes following ESI.
Design: Retrospective chart reviewSetting : Veterans Health AdministrationParticipants : Adults who underwent cervical ESI.
Interventions: Not applicable
Main Outcome Measures: Percentage of pain reduction after cervical ESI
Results: The number of subjects to adequately power this study is 369 patients. A chi-squared analysis was performed with the independent variable as “EMG-confirmed radiculopathy vs no EMG confirmation,” of 47 participants. The dependent variable was categorized as “Responders (>50% pain reduction)” and “Non-Responders ( < 50% pain reduction)” after ESI. The p-value was calculated as 0.11.Conclusions: The results did not show statistical significance of improved pain outcomes after an ESI with those patients that had an EMG confirmation of cervical radiculopathy. However, as the sample size is increased to the anticipated n, we hypothesize that the data will suggest that patients respond better to cervical ESI if their EMG results are indicative of cervical nerve root injury, similar to the studies that establish the predictive role EMGs play in improved responses to lumbar ESIs. The VA is the largest national healthcare system. Therefore, examining the utility of the diagnostic workup for veterans receiving ESIs, and defining who is most likely to benefit, is essential for veteran health and managing expenditures. This may also guide clinical decision-making and can help reduce unnecessary procedures; thereby, mitigating potential exposure to COVID-19.
Level of Evidence: Level III
To cite this abstract in AMA style:Phuphanich ME, Nastasi A, Oshiro R, Kamgar-Parsi A, Shan MX. The Role of Electromyography in Patients Undergoing Cervical Epidural Steroid Injections [abstract]. PM R. 2021; 13(S1)(suppl 1). https://pmrjabstracts.org/abstract/the-role-of-electromyography-in-patients-undergoing-cervical-epidural-steroid-injections/. Accessed December 3, 2023.
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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/the-role-of-electromyography-in-patients-undergoing-cervical-epidural-steroid-injections/