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Do EMG Results Predict Response to Epidural Steroid Injections?

Does Electrodiagnostic Confirmation of Radiculopathy Predict Pain Reduction after Transforaminal Epidural Steroid Injection? A Multicenter Study. Zachary McCormick et al. J Nat Sci. 2015 Aug; 1(8): e140.

Submitted by Ileana Howard, MD, News Science Editorial Board
This paper describes an observational cohort study of 170 patients undergoing transforaminal epidural steroid injection for cervical or lumbar radiculopathy, who had previously undergone EMG within the prior six months. The relationship between EMG diagnosis and pain improvement following epidural steroid injection was evaluated.  At follow-up >30 days post injection, a larger proportion of patients with EMG-confirmed radiculopathy (37.7%) described >50% relief of symptoms as compared to patients with negative EMG (17.8%). This association was significant for lumbar, but not cervical radiculopathy. 

Comment: Prior studies have reported mixed conclusions about the benefit of epidural steroid injections for lumbar radiculopathy, and no previous studies have reported data on EMG as a predictor of response to epidural steroid injections. Previous studies have been limited by small size and diverse procedural interventions. It is important to note that the response to epidural steroid injections for relief of radiculopathy pain was low in this study, likely related to the fact that EMGs were most often ordered to clarify the presence of radiculopathy in patients with atypical presentations.

Epidural steroid injections can provide meaningful improvements in pain and function for individuals with radiculopathy. Determining which patients may benefit most from these interventions, possibly using EMG as an adjunct to clinical information, will help determine the most effective treatment strategies and help contain growing healthcare expenditures. 
About the News Science Editorial Board
The board helps to highlight significant, timely science news items for AANEM members. It reviews articles in journals and websites, identifies newsworthy items in the field, and writes article summaries.

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