Anesthesiology and Pain Medicine

Published by: Kowsar

Electromyographic Findings After Epidural Steroid Injections in Patients with Radicular Low Back Pain: A Prospective Open-Label Study

Chrysanthi Batistaki 1 , * , Athina Angelopoulou 1 , Maria-Eleni Smyrnioti 1 , Maria-Chrysanthi Kitsou 1 and Georgia Kostopanagiotou 1
Authors Information
1 2nd Department of Anesthesiology, School of Medicine, National and Kapodistrian University of Athens, “Attikon” Hospital, Athens, Greece
Article information
  • Anesthesiology and Pain Medicine: December 2017, 7 (6); e62556
  • Published Online: December 27, 2017
  • Article Type: Research Article
  • Received: October 9, 2017
  • Revised: November 21, 2017
  • Accepted: December 15, 2017
  • DOI: 10.5812/aapm.62556

To Cite: Batistaki C, Angelopoulou A, Smyrnioti M, Kitsou M, Kostopanagiotou G. Electromyographic Findings After Epidural Steroid Injections in Patients with Radicular Low Back Pain: A Prospective Open-Label Study, Anesth Pain Med. 2017 ; 7(6):e62556. doi: 10.5812/aapm.62556.

Copyright © 2017, Anesthesiology and Pain Medicine. This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License ( which permits copy and redistribute the material just in noncommercial usages, provided the original work is properly cited.
1. Introduction
2. Methods
3. Results
4. Discussion
  • 1. Abdi S, Datta S, Trescot AM, Schultz DM, Adlaka R, Atluri SL, et al. Epidural steroids in the management of chronic spinal pain: a systematic review. Pain Physician. 2007;10(1):185-212. [PubMed: 17256030].
  • 2. Chou R, Qaseem A, Snow V, Casey D, Cross JJ, Shekelle P, et al. Diagnosis and treatment of low back pain: a joint clinical practice guideline from the American College of Physicians and the American Pain Society. Ann Intern Med. 2007;147(7):478-91. [PubMed: 17909209].
  • 3. Parr AT, Diwan S, Abdi S. Lumbar interlaminar epidural injections in managing chronic low back and lower extremity pain: a systematic review. Pain Physician. 2009;12(1):163-88. [PubMed: 19165302].
  • 4. Imani F, Rahimzadeh P. Interventional pain management according to evidence-based medicine. Anesth Pain Med. 2012;1(4):235-6. doi: 10.5812/aapm.4514. [PubMed: 24904805].
  • 5. Patel VB, Wasserman R, Imani F. Interventional therapies for chronic low back pain, a focused review, (efficacy and outcomes). Anesth Pain Med. 2015;5(4):29716. doi: 10.5812/aapm.29716. [PubMed: 26484298].
  • 6. Marchetti J, Verma-Kurvari S, Patel N, Ohnmeiss DD. Are electrodiagnostic study findings related to a patient's response to epidural steroid injection?. PM R. 2010;2(11):1016-20. doi: 10.1016/j.pmrj.2010.07.002. [PubMed: 21093837].
  • 7. Manchikanti L, Boswell MV, Singh V, Derby R, Fellows B, Falco FJ, et al. Comprehensive review of neurophysiologic basis and diagnostic interventions in managing chronic spinal pain. Pain Physician. 2009;12(4):71-120. [PubMed: 19668292].
  • 8. Manchikanti L, Cash KA, McManus CD, Damron KS, Pampati V, Falco FJ. Lumbar interlaminar epidural injections in central spinal stenosis: preliminary results of a randomized, double-blind, active control trial. Pain Physician. 2012;15(1):51-63. [PubMed: 22270738].
  • 9. Conn A, Buenaventura RM, Datta S, Abdi S, Diwan S. Systematic review of caudal epidural injections in the management of chronic low back pain. Pain Physician. 2009;12(1):109-35. [PubMed: 19165299].
  • 10. NICE guideline (NG59) . Low back pain and sciatica in over 18s, Assessment and management. invasive treatments. methods, evidence and recommendations. London: NICE; 2016, [cited August 15]. Available from:
  • 11. Rahimzadeh P, Sharma V, Imani F, Faiz HR, Ghodraty MR, Nikzad-Jamnani AR, et al. Adjuvant hyaluronidase to epidural steroid improves the quality of analgesia in failed back surgery syndrome: a prospective randomized clinical trial. Pain Physician. 2014;17(1):75-82. [PubMed: 24452659].
  • 12. Fish DE, Shirazi EP, Pham Q. The use of electromyography to predict functional outcome following transforaminal epidural spinal injections for lumbar radiculopathy. J Pain. 2008;9(1):64-70. doi: 10.1016/j.jpain.2007.08.011. [PubMed: 17974488].
  • 13. Bierner SM, Annaswamy TM, Chouteau WL. Predictive value of electromyography for response to epidural steroid injection in patients with lumbar radiculopathy. Muscle Nerve. 2009;40:710.
  • 14. Tong HC, Williams JC, Haig AJ, Geisser ME, Chiodo A. Predicting outcomes of transforaminal epidural injections for sciatica. Spine J. 2003;3(6):430-4. [PubMed: 14609686].
  • 15. Chouteau WL, Bierner SM, Annaswamy TM. Predictive value of electromyography of response to lumbar epidural steroid injections in patients with lumbar radiculopathy. Am J Phys Med Rehab. 2009;88:6. doi: 10.1016/j.clinph.2008.10.143.
  • 16. Tonzola RF, Ackil AA, Shahani BT, Young RR. Usefulness of electrophysiological studies in the diagnosis of lumbosacral root disease. Ann Neurol. 1981;9(3):305-8. doi: 10.1002/ana.410090317. [PubMed: 6261675].
  • 17. Fisher MA. Electrophysiology of radiculopathies. Clin Neurophysiol. 2002;113(3):317-35. [PubMed: 11897532].
  • 18. Delisa JA. . 4th ed. In: Frontera WR, Delisa JA, editors. Philadelphia, United States: Lippincott Williams and Wilkins; 2010. Electrodiagnostic evaluation of the peripheral nervous system, (radiculopathy and polyradiculopathy); 93 p.
  • 19. Levin KH. Electrodiagnostic approach to the patient with suspected radiculopathy. Neurol Clin. 2002;20(2):397-421. [PubMed: 12152441].
  • 20. Nardin RA, Patel MR, Gudas TF, Rutkove SB, Raynor EM. Electromyography and magnetic resonance imaging in the evaluation of radiculopathy. Muscle Nerve. 1999;22(2):151-5. [PubMed: 10024127].
  • 21. Kimura J. Electrodiagnosis in diseases of nerve and muscle. Philadelphia PA: FA Davis Co; 1989.
  • 22. Aminoff MJ, Goodin DS, Parry GJ, Barbaro NM, Weinstein PR, Rosenblum ML. Electrophysiologic evaluation of lumbosacral radiculopathies: electromyography, late responses, and somatosensory evoked potentials. Neurology. 1985;35(10):1514-8. [PubMed: 2993952].
  • 23. Elisen A. Electrodiagnosis of radiculopathies. Neuro Clin. 1985;3(3):494-510. [PubMed: 2995782].
  • 24. Adel T, Stashuk D. Clinical quantitative electromyography. University of Waterloo, Canada: Department of System Design Engineering; 2014.
  • 25. Wilbourn AJ, Aminoff MJ. AAEE minimonograph #32: the electrophysiologic examination in patients with radiculopathies. Muscle Nerve. 1988;11(11):1099-114. doi: 10.1002/mus.880111102. [PubMed: 3067085].
  • 26. Henneman E, Somjen G, Carpenter DO. Functional Significance of Cell Size in Spinal Motoneurons. J Neurophysiol. 1965;28:560-80. doi: 10.1152/jn.1965.28.3.560. [PubMed: 14328454].
  • 27. Daube JR. AAEM minimonograph #11: Needle examination in clinical electromyography. Muscle Nerve. 1991;14(8):685-700. doi: 10.1002/mus.880140802. [PubMed: 1890993].
  • 28. Pino LJ, Stashuk DW, Boe SG, Doherty TJ. Motor unit potential characterization using "pattern discovery". Med Eng Phys. 2008;30(5):563-73. doi: 10.1016/j.medengphy.2007.06.005. [PubMed: 17697793].
  • 29. Hodson-Tole EF, Wakeling JM. Motor unit recruitment for dynamic tasks: current understanding and future directions. J Comp Physiol B. 2009;179(1):57-66. doi: 10.1007/s00360-008-0289-1. [PubMed: 18597095].
  • 30. Roeleveld K, Stegeman DF, Falck B, Stalberg EV. Motor unit size estimation: confrontation of surface EMG with macro EMG. Electroencephalogr Clin Neurophysiol. 1997;105(3):181-8. [PubMed: 9216486].
  • 31. Kraft GH. Fibrillation potential amplitude and muscle atrophy following peripheral nerve injury. Muscle Nerve. 1990;13(9):814-21. doi: 10.1002/mus.880130907. [PubMed: 2233867].
  • 32. Annaswamy TM, Bierner SM, Chouteau W, Elliott AC. Needle electromyography predicts outcome after lumbar epidural steroid injection. Muscle Nerve. 2012;45(3):346-55. doi: 10.1002/mus.22320. [PubMed: 22334168].
  • 33. DeLuca CJ. . In: Basmajian JV, De Luca CJ, editors. Baltimore: William and Wilkins; 1983. Control properties of motor units; p. 125-67.
  • 34. Stashuk DW. Decomposition and quantitative analysis of clinical electromyographic signals. Med Eng Phys. 1999;21(6-7):389-404. doi: 10.1016/s1350-4533(99)00064-8.
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