Stenosis and Negative EMG?

Stenosis and Negative EMG?

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RFLO1
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Joined: 02/24/2009 - 12:41pm
Stenosis and Negative EMG?

Hi everyone, I hope you are all doing well. I was just curious about Lumbar stenosis and EMG tests. I have severe stenosis at L4-L5 with near complete occlusion of the spinal canal. However, I did have an EMG in March and neuro said I had somewhat slow responses, but within range. Is this normal? I have low back pain, pain in groin, buttocks, back of legs, and thighs. Or will it not show up on EMG until there is permanent damage? I have read somewhere that Stenosis is hard to detect on EMG unless they have you exercise until you have pain, and then do the test? Thanks for your responses!

RFLO1

ernurse
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Joined: 06/22/2008 - 9:09am
EMG

I do not know very much about EMG's except from my own experience of having one. This is what my ortho spine surgeon says about EMG's "These tests may help your doctor determine if your problem is due to a nerve abnormality. They must, however, be viewed in association with imaging studies such as an MRI and a complete physical examination. A compressed nerve root in the neck or back may be a source of pain but these tests could still be normal. These tests are also normal when the problem is due to a spinal cord abnormality."

I do not know about exercise before the test. I only had an EMG because work comp insisted on it, my physician was not going to order it because it wouldn't give him any new information in my situation.

John Blunt
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Joined: 12/16/2008 - 3:03pm
EMG?

Did you go to see your Doc for pain or muscle weakness?.

The EMG test either with or after exercise is principally to see metabolic changes in the muscles amongst other things which will determine why there is muscle weakness, nerve damage or muscle/nerve related deficiency.

If you went to your Doc for pain I don't understand why he did not order an MRI.

Perhaps you can be a little more specific.

John B

RFLO1
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Joined: 02/24/2009 - 12:41pm
EMG?

Hi John, I did get an MRI, I had gone to an Orthopedic surgeon, who said he thought it was related to my S1 disk, so he asked for the EMG. After the negative EMG, Ortho doctor told me he wanted to do a discogram because he could not tell where the pain was coming from. I then went to see a top neurosurgeon who reviewed the MRI and stated the following:

at L4-L5 there is severe collapse of the disc space and severe hypertrophy of the articulating facets producing nearly complete occlusion of the spinal canal. Combined with posterior element hypertrpohy this produces severe central canal and lateral recess stenosis.

I do have muscle atrophy in the right leg. I was ust curious about why the EMG did not show any problems when the Neuro said it was quite serious and I need to have a 2 level fusion.

Thanks,

RFLO1

n2waterdogs (not verified)
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spinal stenosis +

I have DDD, Spinal Stenosis, Spondlosenthsis,Pars Fractures L4,L5,S1, I have had 2 MRI's in 6 months, and most of my pain is in the rt. outer calf and some lower back pain that is mostly in the evening.
I have a hard plastic turtle like brace and have recently been issued a tens unit which provides good results when worn in the evening.
I have also just had an EMG which told me I had no nerve involvement, however I did have some nerve pinching when l4,l5, bones slipped forward and my rt. leg gave way and I fell.
Now the pain management center wants to do a Lumbar Medial Branch injection, followed by burning of the nerve roots in the lumbar spine.
Does anyone know if this injection treatment is worth the risk and will it help with leg pain too?
I appreciate any information you can give me.

Ming
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Joined: 11/14/2008 - 9:31pm
EMG's

I've often wondered why they don't do EMG's and MRI's while you are standing. I've heard from others on here that they've had a standing EMG. It just seems to make more sense that the discs or nerves would be more compressed or impinged if you are standing. I'm no expert or medical professional but I feel better when I'm laying down with my legs propped up (like they do for me in MRI and EMG tests) vs when I am standing. I've had a couple MRI's, a CTScan, many xrays and 1 EMG. My recent EMG showed no nerve damage or impingement but I have nerve pain, numbness and tingling in my legs and sciatic so explain that one. Also, MRI taken after surgery didn't show any spinal impingement or narrowing either. I just don't understand how you can have nerve pain without nerve damage or have it showing on any of the tests done.

Can you sense my frustration with this whole thing? ~X(

John Blunt
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Joined: 12/16/2008 - 3:03pm
EMG?

The Atrophy in your leg can be a partial or complete wasting away of muscle. Which is yours? The answer to the EMG result may not have seen the latter.

Atrophy is also sometimes connected to other medical and physical problems and I was wondering if there are any other problems in your case?

Did your doc tell you that there were any alternatives to a two level fusion, like disc replacement?

I never like to accept the first thing I am told, my inner self will not allow that. I always say that it is my body and I have to be fully responsible for it as I know that I will not get another one! Unless someone knows different!

Best

John B

gwennie17
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Joined: 12/30/2008 - 12:07am
I have/had a similar

I have/had a similar diagnosis as you...spondylolisthesis at L4-5 and several central canal stenosis. These problems are easily seen with imaging studies, MRI and X-ray. The following article is helpful in understanding stenosis: http://www.spine-health.com/conditions/spinal-stenosis/definitive-guide-lumbar-spinal-stenosis

Stenosis rarely causes permanent nerve damage. It is extremely uncomfortable and can turn the patient into a couch potato because it hurts to stand or walk...but, it usually does not permanently damage the nerve that is being constricted. If the patient elects to have surgery to open up the space, the nerve usually recovers and the pain subsides.

In terms of the EMG, I think you'll find that exercise would make little difference with stenosis. The central canal is narrowed for a reason --enlarged facet joints, a herniated disc, etc., and no amount of exercise will change that structural problem.

RFLO1
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Joined: 02/24/2009 - 12:41pm
Thank you for your responses

John, it is only partial atrophy, not full muscle wasting. gwennie, thank you for the additional info also. I was curious if stenosis would cause permanent damage over the long run. My neuro wants to do a PLIF at L4-L5 and also do exploratory at the L5-S1 as there is no disk left there, but is not sure if it auto-fused. I had a lamenectomy at L5-S1 in 1992, and had osteomyelits which they had to open me back up to remove. I am very concerned about having the surgery as I am also on plavix for 5 stents which 2 closed when coming off plavix in the past. My neuro will not touch me until I come off it for 6 weeks. My wife does not want me to have the surgery as she thinks it is not safe and will not help with back pain in the long run.
Thanks, RFLO1

John Blunt
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Joined: 12/16/2008 - 3:03pm
RLFO1

It seems that all your issues and concerns clearly need to be taken into account with whatever path you are considering. I can fully appreciate the concerns of your good lady wife here as she wants to protect you. She needs to have confidence in whatever your are doing as indeed do you.

Maybe you need a meeting of the minds here with your docs around one table to discuss the best course of action for you, thereby putting everything into sensible perspective. If you can't achieve that then maybe you need a case manager, or have your family practitioner take that roll for you. At least that way your best interests may be served with all your issues taken into consideration.

Some docs might just think a little more constructively when they are part of a team too.

John B