Spinal Disorders: Fundamentals of Diagnosis and Treatment Part 36. Spinal disorders are among the most common medical conditions with significant impact on health related quality of life, use of health care resources and socio-economic costs. Spinal surgery is still one of the fastest growing areas in clinical medicine. | 332 Section Patient Assessment Strengths The combination of radiological clinical and neurophysiological testing is improving diagnostic sensitivity and specificity. In atypical presentation of the disorder or in patients with other accompanying diseases the affection of nerve function at the stenotic area can be disclosed and quantified 2 4 neuropathies can be excluded that can induce similar pain syndromes numbness of feet due to peripheral neuropathy 1 26 Weaknesses Comparable to cervical stenosis there is only a low correlation of the radiological findings extent and type of spinal canal stenosis to the clinical complaints electrophysiological findings are not correlated to the extent of clinical complaints in combined spinal and peripheral nerve disorders the specificity of the neurophysiological recordings is reduced Neurophysiology in Differential Diagnosis Not only in the population of elderly patients do several differential diagnoses have to be considered but especially when the complaints are demonstrated in an atypical presentation. Neurophysiological studies allow radiculopathy to be differentiated from peripheral neuropathy Peripheral Nerve Lesion Versus Radiculopathy Damage to the nerve roots presents in a radicular distribution see Chapters 8 11 of sensory dermatome and motor myotome deficits and electrophysiological measurements are able to distinguish a peripheral nerve affection from a radiculopathy. A peripheral nerve lesion like the compression of the peroneal nerve close to the fibula head induces pathological findings in NCS conduction failure with reduced or even abolished CMAP and pathological EMG findings in the distal muscles innervated by the peroneal nerve while a complete motor L5 radiculopathy shows no NCS pathology but produces pathological EMG findings signs of denervation in both the distal anterior tibial muscle and the proximal gluteus medius paravertebral muscles L5 innervated muscles. Neurophysiological studies allow the .
