RU2455929C1 - Method of estimating ischialgia intensity in case of discogenic radicular syndrome - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to medicine, namely to diagnostics and neurology. Electroneuromyographies (EMG) are performed. Numerical value of ratio of average amplitude of total EMG of significant lower extremity muscle, registered in conditions of functional tension of affected nerve trunk, and maximal amplitude of "motor response" of tested muscle is determined. Obtained value is compared with similar value of said index of healthy person and, if it constitutes to 30% from the level of the latter one, presence of considerably expressed pain syndrome in patient is diagnosed; 31-60% - presence of moderately expressed pain syndrome is diagnosed; higher than 60% - presence of weakly expressed pain syndrome is diagnosed.

EFFECT: method ensures objective evaluation of presence and intensity of ischialgia.

3 cl, 2 tbl, 2 ex

Description

The invention relates to medicine, in particular to neurology, neurosurgery, and can be used to diagnose the presence and assess the degree of intensity of sciatica in patients with discogenic radicular syndrome.

A known method for assessing the degree of intensity of sciatica using scoring systems: Visual analogue scale (VAS), Digital rating scale (NRS), Verbal rating scale (VRS), Pain intensity scale (PPI), McGill pain assessment questionnaire (MPQ) (Kadykov A. C. Rehabilitation of neurological patients / A.S. Kadykov, L.A. Chernikova, N.V. Shakhparonova. - M.: MEDpress-inform, 2009. - 560 p.).

However, this method is largely characterized by the subjectivity of pain assessment, the interpretation of the results is not always accurate, special attention is required to elderly patients.

The objective of the invention is to develop a method that provides an objective assessment of the presence and intensity of sciatica in discogenic radicular syndrome.

This problem is solved by the fact that in the method for assessing the intensity of sciatica with discogenic radicular syndrome, including the implementation of electroneuromyography, the numerical value of the ratio of the average amplitude of the total EMG of the diagnostically significant muscle of the lower limb recorded under the functional tension of the injured nerve trunk to the maximum amplitude of the “motor response” is determined of the tested muscle, compare it with the value of a similarly calculated indicator of a healthy person and, if it’s composition up to 30% of the level of the latter, the patient is diagnosed with a significantly expressed pain syndrome, with values of 31-60%, the presence of a moderate pain syndrome and over 60% of a mild pain syndrome. At the same time, it is provided that with radiculopathy L5, m. gastrocnemius (cap.lat.) under conditions of the maximum possible back flexion of the foot, and with radiculopathy S1 - m.tibialis anterior under the conditions of the maximum possible plantar flexion of the foot.

The implementation of the method illustrates the description and examples of its clinical use.

The method is as follows.

The study is performed using EMG systems, for example, the Viking-4 digital EMG system (Nicolet, USA). Bioelectric activity is removed by bipolar surface electrodes. In case of L5 radiculopathy, the patient performs the test movement “plantar foot flexion” on the side of the root compression and the EMG activity m is recorded. gastrocnemius (cap.lat.), with radiculopathy S1 - “back flexion of the foot” on the side of the root compression with the abduction of biopotentials from m. tibialis anterior. The patient is instructed that the test movement should be performed with the maximum possible effort and amplitude, but not overcoming the emerging acute pain. The calculation of the average amplitude of the total EMG is performed using the “MVA-test” (Motor Voluntary Activity Test) program, which provides automated calculation of the MRV (Mean Rectified Voltage) indicator. The obtained MVR value is multiplied by "2" in order to bring this indicator to the average amplitude of the total EMG (SA _EMG ), not subjected to biannual rectification.

“Motor responses” of the same muscles are recorded unipolarly (abduction of the “belly-tendon” type). The stimulus duration is 1 ms, the intensity is supramaximal. “Motor responses” m.tibialis anterior and m.gastrocnemius (cap.lat.) Are recorded during stimulation of n.peroneus and n.tibialis at the level of the knee joint, respectively. The indicator used is the amplitude “from peak to peak” (A _M-response ).

Following this, for the corresponding muscle of the affected lower limb, the numerical value of the ratio of the average amplitude of the total EMG recorded under the conditions of the test “maximum possible foot flexion” to the maximum amplitude of the “motor response” of the tested muscle is determined: SA _EMG / A _M-RESPONSE . The obtained numerical value of this ratio is compared with a healthy person calculated in a similar way. In particular, Table 1 shows the average SA _EMG / A ratios of the _{M-response of the} tested muscles recorded in 32 healthy subjects (students of the physical education department of the male university of 17-21 years old).

Table 1 Average (M ± m) EMG values recorded in healthy subjects Muscle SA _EMG And the _M-answer CA _EMG / A _M-response m.tibialis anterior 0.65 ± 0.03 7.85 ± 0.17 0.094 ± 0.008 m.gastrocnemius (cap.lat.) 0.40 ± 0.05 31.46 ± 0.46 0.016 ± 0.001

Since there was no statistically significant difference between the average values of the analyzed ratio of the left and right limbs in the subjects examined by us, this is evidence of the initial morphofunctional motor symmetry in the framework of the test used (all subjects are right-handed). Table 1 presents the average values for the combined (left + right) data sample.

If the analyzed indicator is up to 30% of the level of a healthy person, the patient is diagnosed with a significantly expressed pain syndrome, with its values of 31-60%, with a moderate pain syndrome, and over 60% with a mild pain syndrome.

The practical use of the method is illustrated by the following clinical observations:

Example 1

Patient S., 35 years old. Diagnosis: Lumbar disc osteochondrosis L5-S1, III-period. Paramedian disc herniation L5-S1 on the right, compression S1 root on the right. Complaints of pain in the lumbar spine, aggravated by physical exertion, with radiation to the right lower limb along the posterior outer surface of the thigh and lower leg. Neurologically: torso forward painful in the lumbar region. The symptom of Lasega is positive on the right. Achilles reflex on the right is reduced, plantar flexion of the right foot - 4 points. Hypesthesia in dermatome S1 on the right.

When conducting an EMG examination on the lead from m.tibialis anterior on the compression side, a moderate decrease in the average amplitude of the total EMG was detected (SA _EMG was 55.4% of the norm) with the amplitude of the "motor response" close to the normative level (94.3% of norms) (table 2). The revealed phenomenon indicates a reflex limitation of the voluntary tension of the test muscle due to increased nociceptive impulses from the lumbar region and along the main nerve trunks, which indirectly characterizes the degree of intensity of pain sensations arising in a patient under conditions of performing a functional test. As a result of processing EMG data, the calculated ratio of the indicators was 41.7% of the norm, which indicates a moderate pain syndrome.

table 2 EMG muscle parameters on the side of the root compression in patients with radiculopathy L5 and S1 A patient Muscle examined SA _EMG A _M-answer CA _EMG / A _M-response B. S. (35 years) m.tibialis anterior 0.29 7.40 0,039 B. D. (43 years) m.gastrocnemius (cap.lat.) 0,07 22.24 0.003

Example 2

Patient D., 43 years old. Diagnosis: Lumbar disc osteochondrosis L4-5, III-period. Right-sided paramedian disc herniation L4-5. Radicular syndrome L5 on the right. Complaints of pain in the lumbar region, radiating to the right lower limb. Neurologically: Torso forward is sharply painful in the lumbar region. Laseg's symptom is sharply positive on the right. Achilles reflex on the right is reduced, back flexion of the right foot - 4 points. Hypesthesia in dermatome L5 on the right.

When conducting an EMG examination on the lead from m.gastrocnemius (cap.lat.) On the compression side, a sharp decrease in the average amplitude of the total EMG (SA _EMG was 17.5% of the norm) was revealed with a moderately reduced maximum amplitude of the “motor response” (70, 7% of the norm). As a result of processing EMG data, the calculated ratio of the indicators was 19.4% of the norm, which indicates a pronounced pain syndrome.

Using the proposed method in the clinic RSC "WTO" them. Acad. G.A. Ilizarova showed that its use provides an objective and accurate diagnosis and can be considered as a quantitative characteristic of the severity of nociceptive impulses in patients with sciatica against the background of discogenic radicular syndrome.

Claims (3)

1. A method for assessing the intensity of sciatica in discogenic radicular syndrome, including performing electroneuromyography, characterized in that the numerical value of the ratio of the average amplitude of the total EMG of the diagnostically significant muscle of the lower extremity recorded under the functional tension of the injured nerve trunk and the maximum amplitude of the “motor response” of the test muscles, compare it with the value of a similarly calculated indicator of a healthy person and, if it is up to 30% of ovnya latter is diagnosed if the patient has a significant expression of pain, for the values that make up 31-60% - the presence of moderate pain, and more than 60% - mild pain. 2. The method according to claim 1, characterized in that with radiculopathy L5 examine m.gastrocnemius (cap.lat.) In the conditions of performing the maximum possible back flexion of the foot. 3. The method according to claim 1, characterized in that with radiculopathy S1, m.tibialis anterior is examined under conditions of the maximum possible plantar flexion of the foot.