Die elektromyografische Untersuchung der paraspinalen Muskulatur: Technische Durchführung, Indikationen und diagnostische Aussagekraft

Zusammenfassung

Die elektromyografische Untersuchung der paraspinalen Muskulatur (PM) ist kein fester Bestandteil der neurophysiologischen Abklärung. Bei einigen Fragestellungen stellt die Elektromyografie der PM jedoch eine wichtige Ergänzung zur Untersuchung der Extremitätenmuskulatur dar. Pathologische Spontanaktivität ist in der PM ohne Probleme zu beurteilen. Die Unterscheidung zwischen einem neurogenen und myopathischen Muster bereitet durch die unterschiedliche Potenzialgröße in den verschiedenen Wirbelsäulenabschnitten und die Grenzen der Potenzialregistrierung im Alltag eher Schwierigkeiten. Im höheren Lebensalter kann pathologische Spontanaktivität in der PM gelegentlich vorkommen, ohne dass eine Erkrankung zugrunde liegen muss. Eine Höhenlokalisation des betroffenen Segmentes bei radikulären Läsionen ist aufgrund der polysegmentalen Innervation der PM nicht möglich. Es ist zu beachten, dass die häufiger anzutreffenden Plexusläsionen (Armplexusneuritis, diabetische Plexopathie) auch die Nervenwurzeln einbeziehen können. Schließlich ist das EMG der PM eine wertvolle diagnostische Stütze beim Nachweis eines generalisierten Vorderhornprozesses.

Abstract

Electromyographic examination of the paraspinal muscles is not an inherent part of the electrophysiological investigation. In some situations, however, electromyographic examination of the paraspinal muscles provides important information supplementary to the findings in the muscles of the extremities. Fibrillations and positive sharp waves in the paraspinal muscles are easily assessed. Because of the different sizes of the motor unit potentials of the cervical, thoracal and lumbar paraspinal muscles and the limitations of single motor unit potential analysis in daily routine, the differentiation between a neurogenic and a myopathic process remains difficult. Localisation of the damaged nerve root is not possible, because the paraspinal muscles are innervated polysegmentally. It must be taken into account that lesions of the brachial und lumbar plexus (neuralgic amyptrophy, diabetic amyotrophy) may include the nerve roots. Finally, electromyography of the paraspinal muscles constitutes a useful tool in the diagnosis of anterior horn diseases.

Schlüsselwörter

Elektromyografie - paraspinale Muskulatur - axiale Myopathie - konzentrische Nadel - technische Anleitung

Key words

electromyography - paraspinal muscles - axial myopathy - concentric needle - technical instructions

• Literatur

• 1 Kimura J. Electrodiagnosis in Diseases of Nerve and Muscle: Principles and Practice. 3 ^rd ed. New York, NY: Oxford University Press; 2001
• 2 Haig AJ, Moffroid M, Henry S et al. A technique for needle localization in paraspinal muscles with cadaveric confirmation. Muscle Nerve 1991; 14: 521-526
• 3 Travlos A, Trueman S, Eisen A. Monopolar needle evaluation of paraspinal musculature in the cervical, thoracic, and lumbar regions and the effects of aging. Muscle Nerve 1995; 18: 196-200
• 4 Barkhaus PE, Periquet MI, Nandedkar SD. Quantitative motor unit action potential analysis in paraspinal muscles. Muscle Nerve 1997; 20: 373-375
• 5 Al-Shekhlee A, Shapiro BE, Preston DC. Iatrogenic complications and risks of nerve conduction studies and needle electromyography. Muscle Nerve 2003; 27: 517-526
• 6 Miller J. Pneumothorax. Complication of needle EMG of thoracic wall. N J Med 1990; 87: 653
• 7 Caress JB, Rutkove SB, Carlin M et al. Paraspinal muscle hematoma after electromyography. Neurology 1996; 47: 269-272
• 8 Hawley RJ. Preventing complications of electromyography. Electromyogr Clin Neurophysiol 2000; 40: 323-325
• 9 MacIntosh JE, Valencia S, Bogduk N et al. The morphology of the human multifidus. Clin Biom 1986; 1: 196-204
• 10 Bogduk N, Wilson AS, Tynan W. The human lumbar dorsal rami. J Anat 1982; 134: 383-397
• 11 Morris JM, Benner G, Lucas DB. An electromyographic study of the intrinsic muscles of the back in man. J Anat 1962; 96: 509-520
• 12 Greiner TM, Bedford ME, Walker RA. Variability in the human m. spinalis capitis and cervicis: frequencies and definitions. Ann Anat 2004; 186: 185-191
• 13 Mayoux-Benhamou MA, Revel M, Wybier M et al. Computerized tomographical study of dorsal neck muscles for insertion of EMG wire electrodes. J Electromyogr Kinesiol 1995; 5: 101-107
• 14 Anderson JS, Hsu AW, Vasavada AN. Morphology, architecture, and biomechanics of human cervical multifidus. Spine (Phila Pa 1976). 2005; 30: E86-E91
• 15 Kottlors M, Glocker FX. Polysegmental innervation of the medial paraspinal lumbar muscles. Eur Spine J 2008; 17: 300-306
• 16 Stein J, Baker E, Pine ZM. Medial paraspinal muscle electromyography: techniques of examination. Arch Phys Med Rehabil 1993; 74: 497-500
• 17 Chiodo A, Goodmurphy C, Haig A. Cadaver evaluation of EMG needle insertion techniques used to target muscles of the thorax. Spine (Phila Pa 1976). 2006 31. E241-E243
• 18 Honet JC. Pneumothorax and EMG. Arch Phys Med Rehabil 1988; 69: 149
• 19 Carvalho de M, Pinto S, Swash M. Motor unit changes in thoracic paraspinal muscles in amyotrophic lateral sclerosis. Muscle Nerve 2009; 39: 83-86
• 20 Tong HC, Haig AJ, Yamakawa KS et al. Paraspinal electromyography: age-correlated normative values in asymptomatic subjects. Spine (Phila Pa 1976). 2005; 30: E499-E502
• 21 RA Raynor EM, Rutkove SB. Fibrillations in lumbosacral paraspinal muscles of normal subjects. Muscle Nerve 1998; 21: 1347-1349
• 22 Serratrice G, Pouget J, Pellissier JF. Bent spine syndrome. J Neurol Neurosurg Psychiatry 1996; 60: 51-54
• 23 Finsterer J, Strobl W. Presentation, etiology, diagnosis, and management of camptocormia. Eur Neurol 2010; 64: 1-8
• 24 Glocker FX, Meng G, Kress W et al. Isolierte paraspinale Myopathie mit Kamptokormie: ein neuer Subtyp der fazioskapulohumeralen Muskeldystrophie. Klin Neurophys 2010; 41: 189-192
• 25 Kottlors M, Kress W, Meng G et al. Facioscapulohumeral muscular dystrophy presenting with isolated axial myopathy and bent spine syndrome. Muscle Nerve 2010; 42: 273-275
• 26 Jordan B, Eger K, Koesling S et al. Camptocormia phenotype of FSHD: a clinical and MRI study on six patients. J Neurol 2011; 258: 866-873
• 27 Glocker FX, Kottlors M.. Neurophysiologische Diagnostik bei Radikulopathien. Neurophysiol Lab 2010; 32: 141-145
• 28 Haig AJ. Clinical experience with paraspinal mapping. I: Neurophysiology of the paraspinal muscles in various spinal disorders. Arch Phys Med Rehabil 1997; 78: 1177-1184
• 29 Lalive PH, Truffert A, Magistris MR. Lombosacral radiculopathy (L3-S1) and specificity of multifidus EMG. Neurophysiol Clin 2004; 34: 41-47
• 30 Steinke H, Saito T, Miyaki T et al. Anatomy of the human thoracolumbar Rami dorsales nervi spinalis. Ann Anat 2009; 191: 408-416
• 31 Fisher MA, Shivde AJ, Teixera C et al. Clinical and electrophysiological appraisal of the significance of radicular injury in back pain. J Neurol Neurosurg Psychiatry 1978; 41: 303-306
• 32 Czyrny JJ, Lawrence J. The importance of paraspinal muscle EMG in cervical and lumbosacral radiculopathy: review of 100 cases. Electromyogr Clin Neurophysiol 1996; 36: 503-508
• 33 Bornstein PE, Peterson RR. Numerical variation of the presacral vertebral column in three population groups in North America. Am J Phys Anthropol 1966; 25: 139-146
• 34 Kottlors M, Glocker FX. Dermatomyotomal supply in patients with variations in the number of lumbar vertebrae. J Neurosurg Spine 2010; 12: 314-319
• 35 Yagci I, Gunduz OH, Ekinci G et al. The utility of lumbar paraspinal mapping in the diagnosis of lumbar spinal stenosis. Am J Phys Med Rehabil 2009; 88: 843-851
• 36 Hasegawa T, Mikawa Y, Watanabe R et al. Morphometric analysis of the lumbosacral nerve roots and dorsal root ganglia by magnetic resonance imaging. Spine (Phila Pa 1976). 1996; 21: 1005-1009
• 37 Epstein NE. Foraminal and far lateral lumbar disc herniations: surgical alternatives and outcome measures. Spinal Cord 2002; 40: 491-500
• 38 Subramony SH, Wilbourn AJ. Diabetic proximal neuropathy. Clinical and electromyographic studies. J Neurol Sci 1982; 53: 293-304
• 39 Donovan WH, Sumi SM. Diabetic amyotrophy – a more diffuse process than clinically suspected. Arch Phys Med Rehabil 1976; 57: 397-403
• 40 Streib EW, Sun SF, Paustian FF et al. Diabetic thoracic radiculopathy: electrodiagnostic study. Muscle Nerve 1986; 9: 548-553
• 41 Bastron JA, Thomas JE. Diabetic polyradiculopathy: clinical and electromyographic findings in 105 patients. Mayo Clin Proc 1981; 56: 725-732
• 42 Puri V, Chaudhry N, Jain KK et al. Brachial plexopathy: a clinical and electrophysiological study. Electromyogr Clin Neurophysiol 2004; 44: 229-235
• 43 Flaggman PD, Kelly JJ. Brachial plexus neuropathy. An electrophysiologic evaluation. Arch Neurol 1980; 37: 160-164
• 44 Krarup C. Lower motor neuron involvement examined by quantitative electromyography in amyotrophic lateral sclerosis. Clin Neurophysiol 2011; 122: 414-422
• 45 Carvalho de MA, Pinto S, Swash M. Paraspinal and limb motor neuron involvement within homologous spinal segments in ALS. Clin Neurophysiol 2008; 119: 1607-1613
• 46 Douglass CP, Kandler RH, Shaw PJ. An evaluation of neurophysiological criteria used in the diagnosis of motor neuron disease. J Neurol Neurosurg Psychiatry 2010; 81: 646-649
• 47 Kuncl RW, Cornblath DR, Griffin JW. Assessment of thoracic paraspinal muscles in the diagnosis of ALS. Muscle Nerve 1988; 11: 484-492
• 48 Carvalho de M, Pinto S, Swash M. Association of paraspinal and diaphragm denervation in ALS. Amyotroph Lateral Scler 2010; 11: 63-66
• 49 Date ES, Mar EY, Bugola MR et al. The prevalence of lumbar paraspinal spontaneous activity in asymptomatic subjects. Muscle Nerve 1996; 19: 350-354
• 50 Date ES, Kim BJ, Yoon JS et al. Cervical paraspinal spontaneous activity in asymptomatic subjects. Muscle Nerve 2006; 34: 361-364
• 51 Gilad R, Dabby R, Boaz M et al. Cervical paraspinal electromyography: normal values in 100 control subjects. J Clin Neurophysiol 2006; 23: 573-576
• 52 Chouteau WL, Annaswamy TM, Bierner SM et al. Interrater reliability of needle electromyographic findings in lumbar radiculopathy. Am J Phys Med Rehabil 2010; 89: 561-569
• 53 LaBan MM, Grant AE. Occult spinal metastases – early electromyographic manifestation. Arch Phys Med Rehabil 1971; 52: 223-226
• 54 Tiple D, Fabbrini G, Colosimo C et al. Camptocormia in Parkinson disease: an epidemiological and clinical study. J Neurol Neurosurg Psychiatry 2009; 80: 145-148
• 55 Margraf NG, Wrede A, Rohr A et al. Camptocormia in idiopathic Parkinson’s disease: a focal myopathy of the paravertebral muscles. Mov Disord 2010; 25: 542-551
• 56 McCluskey LF. Camptocormia: pathogenesis, classification, and response to therapy. Neurology 2006; 66: 1285-1286
• 57 Azher SN, Jankovic J. Camptocormia: pathogenesis, classification, and response to therapy. Neurology 2005; 65: 355-359
• 58 Kuruoglu R, Oh SJ, Thompson B. Clinical and electromyographic correlations of lumbosacral radiculopathy. Muscle Nerve 1994; 17: 250-251
• 59 Johnson EW, Melvin JL. Value of electromyography in lumbar radiculopathy. Arch Phys Med Rehabil 1971; 52: 239-243
• 60 Zambelis T, Piperos P, Karandreas N. Fibrillation potentials in paraspinal muscles in chronic lumbosacral radiculopathy. Acta Neurol Scand 2002; 105: 314-317
• 61 Hoover BB, Caldwell JW, Krusen EM et al. Value of polyphasic potentials in diagnosis of lumbar root lesions. Arch Phys Med Rehabil 1970; 51: 546-548