The value of neurophysiological and imaging studies in predicting outcome in the surgical treatment of cervical radiculopathy

It is not always easy to predict the degree of symptomatic improvement to be expected in a patient undergoing surgery for cervical disc herniation and radiculopathy. Here we investigate whether preoperative electromyography (EMG) can help select those most likely to benefit from intervention. We prospectively evaluated 20 patients whose required operative level was unclear after clinical examination and MRI scan alone. The surgical procedures was anterior cervical interbody fusion with the AcroMed(R) carbon fibre cage. Clinical assessment employed using validated scoring systems (Prolo functional and economic scoring system). Patients underwent MRI preoperatively, and were assessed pre and postoperatively with neurophysiological studies (NPS) including nerve conduction studies and concentric needle EMG. Patients with preoperative evidence of cervical nerve root involvement on EMG (group A, n = 8) had better outcome (P = 0.001) following discectomy and anterior fusion than patients who had no evidence of nerve root damage on EMG (group B, n = 12). Prolo mean score +/- SEM for group A was 7.375 +/- 0.3750 and for group B was 5.583 +/- 0.2876. Thus, NPS are a valuable tool in selecting patients in this subgroup for cervical surgery.