ABSTRACT
OBJECTIVES: This paper compares the diagnostic sensitivity of two tests in lumbar spinal stenosis (LSS): lumbosacral root stimulation with needle electrodes and needle electromyograph (EMG). MATERIAL AND METHODS: Twenty patients with LSS were assigned to two groups: Patients with 'neurogenic intermittent claudication' (NIC) only (n=11), and patients with 'neurological signs' (n=9). Ten normal subjects were also examined. The effects of direct stimulation of the lumbosacral roots and conventional EMG recorded from important muscles [rectus femoris (RF): L4, tibialis anterior (TA): L5, soleus muscle (SOL): S1], were compared with each other and correlated with their respective clinical findings and radiological images. RESULTS: Needle EMG and nerve conduction study revealed pathology in 15/20 patients, and electrical stimulation of the roots in 17/20 patients. Agreement in radiological findings with electrical stimulation of the roots and EMG was found in 12 patients. The other patients were harmonic with radiological findings either in EMG or in electrical stimulation of the roots. CONCLUSIONS: Electrical root stimulation revealed more abnormalities in patients with LSS in comparison with needle EMG. However, both methods seemed to complement each other to show additional pathology in a given patient.
Subject(s)
Electromyography , Lumbosacral Plexus/pathology , Spinal Stenosis/diagnosis , Adult , Electric Stimulation , Female , Humans , Lumbosacral Plexus/physiology , Male , Middle Aged , Muscle, Skeletal/innervation , Muscle, Skeletal/physiology , Needles , Neural ConductionABSTRACT
Cervical dystonia (spasmodic torticollis) is a focal dystonia of the cervical region. Various treatment modalities have been performed with variable success rates. We present a 42-year-old woman complaining of involuntary head rotation for the last 3 years. Different medical treatments had been used for 3 years. Botulinum toxin injections resulted in temporary and moderate improvement for periods of 3-4 months. Pallidal stimulation was performed using a quadripolar electrode and a battery-operated programmable pulse generator. We conclude that a unilateral pallidal lesion or stimulation is an effective method of treatment in focal dystonia. The target must be the pallidum contralateral to the contracted sternocloidomastoid muscle. Deep brain stimulation is superior to lesioning because of the capability of manipulating the stimulation parameters which can modify the pallidotomy effect.
