Discrepancy between clinical-neurophysiological-neuroimaging examinations in lumbar spine degenerative disease: To the neurosurgeon the choice

Abstract

Background: Degenerative lumbar spinal surgery is preceded by diagnostic investigations, like clinical, radiological, neurophysiological ones. The presurgical evaluation is made easier by the concordance of the diagnostic investigations. In a percentage of cases, however, there is a discrepancy, especially with regard to the correlation between electromyography and neuroimaging. It is the case of a normal EMG and a CT or MRI showing the presence of a protrusion or a herniated disc. Material and methods: Our study covers 30 subjects suffering from herniated disc pain and undergone surgery. 15 patients presented with lumbar pain, with CT and MRI showing herniated disc, but normal electromyographic results. Despite this discordance, all patients underwent surgery. Results: The results were satisfactory. The results of this study highlighted the possible discrepancy between neurophysiological, neuroradiological and clinical examinations but the surgeon's decision to intervene was appropriate since the 5-year follow-up showed the resolution of the disc pathology, with disappearance of pain. Conclusions: The discrepancy between the diagnostic examinations is a problem creating for the purpose of the preoperative evaluation, whereby the decision to intervene is entrusted to neurosurgeon, who will choose the better option for surgery. Keywords: Herniation disc, Lumbar spine, Neuroimaging, Elecromyography