Efficacy of intraoperative direct electrical stimulation of the spinal root and measurement of distal motor latency in lumbar spinal stenosis.
The measurement of distal motor latency (DML) is an established method for diagnosing entrapment peripheral neuropathy. DML can also serve as an index for disease severity and prognosis. We considered that measuring DML could be useful in estimating the severity of spinal root impairment and predicting prognosis in patients with lumbar spinal stenosis (LSS). The purpose of this study was to investigate the efficacy of intraoperative direct electrical stimulation of the spinal root and the measurement of DML in LSS.



In 39 patients with LSS, a total of 93 spinal roots were stimulated, and evoked electromyography was recorded at the leg muscles after decompression. DML was measured and its correlation with clinical severity, as evaluated by Zurich claudication questionnaire (ZCQ) and Short Form 36 (SF-36), was investigated.



For the stimulation of the L3, L4, and L5 spinal root, the mean DML (ms) were 6.8 (±1.4), 7.4 (±1.3), and 6.0 (±1.3) in gluteus medius, 9.3 (±1.5), 9.2 (±1.5), and 9.0 (±1.6) in biceps femoris, 9.7 (±1.0), 9.8 (±1.8), and 9.4 (±1.2) in vastus medialis, 16.1 (±1.0), 14.7 (±1.3), and 14.1 (±1.5) in tibialis anterior, and 16.4 (±1.4), 14.3 (±1.8), and 13.9 (±1.9) in gastrocnemius muscles. Statistically significant positive correlations were observed between DML and height. Preoperative symptom and function scores of ZCQ and postoperative bodily pain scores of SF-36 were significantly worse in the patients with prolonged DML.



DML is thought to be useful for estimating the severity of spinal root impairment and for predicting the prognosis.
Department of Clinical Engineering, Sapporo Medical University Hospital, S1 W16, Sapporo, Hokkaido, 060-8543, Japan.
Takao
T
Murohashi
Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, S1 W16, Sapporo, Hokkaido, 060-8543, Japan. myoshimo@sapmed.ac.jp.
Mitsunori
M
Yoshimoto
Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, S1 W16, Sapporo, Hokkaido, 060-8543, Japan.
Tsuneo
T
Takebayashi
Department of Clinical Engineering, Sapporo Medical University Hospital, S1 W16, Sapporo, Hokkaido, 060-8543, Japan.
Shuichi
S
Hashimoto
Department of Clinical Engineering, Sapporo Medical University Hospital, S1 W16, Sapporo, Hokkaido, 060-8543, Japan.
Shouto
S
Yamada
Division of Radiology and Nuclear Medicine, Sapporo Medical University Hospital, S1 W16, Sapporo, Hokkaido, 060-8543, Japan.
Hiroyuki
H
Takashima
Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, S1 W16, Sapporo, Hokkaido, 060-8543, Japan.
Toshihiko
T
Yamashita
D000368:Aged; D019299:Decompression, Surgical; D004558:Electric Stimulation; D004576:Electromyography; D019054:Evoked Potentials, Motor / Q000502:physiology*; D005260:Female; D006801:Humans; D007432:Intraoperative Period; D008159:Lumbar Vertebrae / Q000503:physiopathology* / Q000601:surgery; D008297:Male; D018482:Muscle, Skeletal / Q000502:physiology; D011379:Prognosis; D012720:Severity of Illness Index; D013126:Spinal Nerve Roots / Q000503:physiopathology*; D013130:Spinal Stenosis / Q000503:physiopathology* / Q000601:surgery
Distal motor latency; Lumbar foraminal stenosis; Lumbar spinal stenosis; Prognostic factor