Objectives: The clinical syndrome of spinal stenosis is a significant problem for older Americans. Although stenosis causes neurogenic claudication, spinal canal size does not accurately predict the severity of symptoms. A pilot study shows that paraspinal muscle denervation relates to spinal canal size in symptomatic persons. It is possible that paraspinal denervation is a more accurate marker for the clinical syndrome than anatomical imaging. Other research shows that paraspinal denervation in a particular distribution also occurs in younger asymptomatic persons, and denervation increases with age. It is possible that paraspinal denervation causes subtle hypermobility and contributes to Kirkaldy-Willis's degenerative cascade of facet hypertrophy and canal stenosis.
Specific Aims : 1. To assess whether paraspinal EMG scores or MRI measurements of stenosis relate best with the clinical syndrome in older persons. 2. To assess whether paraspinal EMG scores predict future symptoms of stenosis and future symptom severity in older persons with and without spinal stenosis. 3. To assess whether change in clinical status relates better to change in paraspinal EMG scores or change in MRI measurement of stenosis. 4. To assess the rate of denervation of the paraspinal muscles in older persons with and without back symptoms. Research Design: Blinded longitudinal study. Methods: Five groups of 30 subjects older than 55 years old, including: asymptomatic persons (healthy persons without low back pain) from the community, persons with lock back pain (LBP) but no stenosis on MRI, persons with stenosis symptoms with mild, moderate, and severe radiographic findings. An experienced neuroradiologist will measure spinal canal size and assign subjects to appropriate categories. A patient questionnaire, physical examination, a walking tolerance test with long latency nerve conduction studies (F- and H- waves) before and after walking, a 7-day pedometer test, and a measure of the flexion-relaxation phenomenon will be administered to the subjects. An unblinded examiner will perform one aspect of the MiniPM paraspinal EMG technique to acclimatize the patient, then a blinded examiner will perform the entire MiniPM, one extremity EMG, sensory and motor nerve conduction studies. Subjects will repeat the test battery (MRI, EMG, and clinical evaluation) approximately 18 months later. Appropriate statistics will test each of the four hypotheses.

Agency
National Institute of Health (NIH)
Institute
National Institute of Neurological Disorders and Stroke (NINDS)
Type
Research Project (R01)
Project #
5R01NS041855-03
Application #
6639804
Study Section
Geriatrics and Rehabilitation Medicine (GRM)
Program Officer
Kleitman, Naomi
Project Start
2001-06-01
Project End
2006-05-31
Budget Start
2003-06-01
Budget End
2006-05-31
Support Year
3
Fiscal Year
2003
Total Cost
$377,500
Indirect Cost
Name
University of Michigan Ann Arbor
Department
Physical Medicine & Rehab
Type
Schools of Medicine
DUNS #
073133571
City
Ann Arbor
State
MI
Country
United States
Zip Code
48109
Roszell, Karin; Sandella, Danielle; Haig, Andrew J et al. (2016) Spinal Stenosis: Factors That Influence Patients' Decision to Undergo Surgery. Clin Spine Surg 29:E509-E513
Haig, Andrew J; London, Zachary; Sandella, Danielle E (2013) Symmetry of paraspinal muscle denervation in clinical lumbar spinal stenosis: support for a hypothesis of posterior primary ramus stretching? Muscle Nerve 48:198-203
Tomkins-Lane, Christy C; Haig, Andrew J (2012) A review of activity monitors as a new technology for objectifying function in lumbar spinal stenosis. J Back Musculoskelet Rehabil 25:177-85
London, Zachary; Quint, Douglas J; Haig, Andrew J et al. (2012) The risk of hematoma following extensive electromyography of the lumbar paraspinal muscles. Muscle Nerve 46:26-30
Tomkins-Lane, Christy C; Conway, Justin; Hepler, Charles et al. (2012) Changes in objectively measured physical activity (performance) after epidural steroid injection for lumbar spinal stenosis. Arch Phys Med Rehabil 93:2008-14
Tomkins-Lane, Christy C; Holz, Sara Christensen; Yamakawa, Karen S et al. (2012) Predictors of walking performance and walking capacity in people with lumbar spinal stenosis, low back pain, and asymptomatic controls. Arch Phys Med Rehabil 93:647-53
Tong, Henry C (2011) Specificity of needle electromyography for lumbar radiculopathy in 55- to 79-yr-old subjects with low back pain and sciatica without stenosis. Am J Phys Med Rehabil 90:233-8; quiz 239-42
Haig, Andrew J; Yamakawa, Karen S J; Parres, Christopher et al. (2009) A prospective, masked 18-month minimum follow-up on neurophysiologic changes in persons with spinal stenosis, low back pain, and no symptoms. PM R 1:127-36
Haig, Andrew J; Geisser, Michael E; Tong, Henry C et al. (2007) Electromyographic and magnetic resonance imaging to predict lumbar stenosis, low-back pain, and no back symptoms. J Bone Joint Surg Am 89:358-66
Chiodo, Anthony; Haig, Andrew J; Yamakawa, Karen S J et al. (2007) Needle EMG has a lower false positive rate than MRI in asymptomatic older adults being evaluated for lumbar spinal stenosis. Clin Neurophysiol 118:751-6

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