Electromyographic technique for lumbar multifidus examination: comparison of previous techniques used to localize the multifidus.
OBJECTIVE
To verify and compare established techniques for needle localization in the multifidus muscle and to explore more practical techniques.


METHODS
Human cadaver study.


METHODS
Anatomy laboratory in a university setting.


METHODS
Six fresh human cadavers.


METHODS
A 22-gauge needle was inserted into the multifidus muscle fascicle of 6 cadavers using 2 different techniques described previously in the electrodiagnostic literature by Haig and Stein and colleagues. A mixture of colored latex and contrast dyes (0.1 mL) was injected bilaterally into each fascicle at levels L1 to L5. Two electromyographers performed injections into 60 targeted muscles, affording 120 total insertions. Separate investigators dissected the muscles to determine dye position.


METHODS
Not applicable.


RESULTS
A total of 88 (73%) and 79 (66%) injections were successfully delivered to the targeted multifidus muscles using the Haig and the Stein techniques, respectively. With the Haig method, 22 injections (18%) were delivered to different superficial muscles. With the Stein method, 24 injections were delivered to a common tendon and 3 injections were delivered to the spinal canal.


CONCLUSIONS
This study highlights the nonoptimizing accuracy of previous techniques for multifidus needle electromyography. A modified Haig method involving less acute needle angulation relative to the skin surface and closer insertion from the midline may increase accuracy and safety.
Kim
Byung Jo
BJ
Department of Neurology, Korea University College of Medicine, Seoul, Korea. nukbj@korea.ac.kr
Date
Elaine S
ES
Derby
Richard
R
Lee
Sang-Heon
SH
Seo
Kwan Sik
KS
Oh
Kwang Joon
KJ
Kim
Mi Jung
MJ
D000368:Aged; D000369:Aged, 80 and over; D002102:Cadaver; D004396:Coloring Agents / Q000008:administration & dosage; D003287:Contrast Media / Q000008:administration & dosage; D004576:Electromyography / Q000379:methods*; D005260:Female; D005471:Fluoroscopy; D006801:Humans; D007273:Injections, Intramuscular; D008161:Lumbosacral Region / Q000502:physiology; D008297:Male; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000502:physiology*; D009339:Needles; D010808:Physical Examination / Q000379:methods*
D004396:Coloring Agents; D003287:Contrast Media