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Abstract(s)
As radiculopatias lombares referem-se a um processo patológico envolvendo as
raízes nervosas espinais, causando sintomas radiculares ao nível dos membros inferiores.
As respostas-F são ondas tardias que advêm de descargas recorrentes de neurónios motores
despolarizados antidromicamente, que podem ser úteis na avaliação de lesões radiculares.
Com o objetivo de avaliar a utilidade dos estudos de condução nervosa e respostas-
F do nervo peronial no diagnóstico de radiculopatia de L5 e a sua correlação com o seu
grau de gravidade, foram estudados 47 sujeitos que padeciam de radiculopatia de L5 e
foram comparados com um grupo de controlo, constituído por 28 sujeitos saudáveis.
Foram estudadas as amplitudes do PAMC do nervo peronial profundo, do PANS do
peronial superficial, bem como as latências mínima, média e máxima, cronodispersão e
persistência das Respostas-F. Foi realizada ainda uma avaliação eletromiográfica, com o
intuito de classificar o acometimento da raiz em termos de gravidade.
Registaram-se diferenças significativas entre os dois grupos na amplitude do
PAMC do peronial profundo (p<0,0001), na F-mínima, F-média, F-máxima e
cronodispersão (p<0,0001), e ainda na persistência (p 0,014). Todos estes parâmetros
também se correlacionaram significativamente com o grau de gravidade da radiculopatia,
sendo as latências das ondas-F e a cronodispersão progressivamente maiores nos sujeitos
com um grau de afeção mais grave, e a persistência e a amplitude dos estudos de condução
motora mais baixas. O fator que se evidenciou mais sensível no diagnóstico desta patologia
foi a latência-máxima das ondas-F, 31,25%, e o menos sensível a persistência, apenas
alterada em 9,34% dos indivíduos. Tendo em consideração todos os parâmetros avaliados
nas respostas-F atingiu-se uma sensibilidade global desta técnica de 42,19%.
Com esta investigação concluímos que os estudos de condução nervosa e as
respostas-F poderão ser úteis como complemento na avaliação das radiculopatias lombares,
apresentando uma sensibilidade considerável para esta patologia. Não se deve limitar o
estudo desta técnica à avaliação das latências mínima das ondas-F, mas incluir sempre
todos os outros parâmetros, aumentando assim a sua sensibilidade. Estas técnicas deverão
ser incluídas no estudo das radiculopatias de L5.
The lumbar radiculopathy refers to a pathological process involving spinal nerve roots, causing radicular symptoms in the lower limbs. F-responses are late waves that come from recurrent discharges of motor neurons depolarized antidromically, which may be useful in evaluating root lesions. The goal of this study is to evaluate the use of nerve conduction studies and Fresponses of the Peronial nerve in the diagnosis of L5 radiculopathy and its correlation with the degree of severity. We studied 47 subjects suffering from L5 radiculopathy, compared with a control group consisting of 28 healthy individuals. We evaluate the amplitudes of the deep Peroneal nerve CMAP, the superficial Peroneal SNAP, F-responses in terms of minimal, mean, maximum latencies, chronodispersion and persistence. In order to classify the severity of lesion of the root we also performed an electromyographic evaluation. Were noticed significant differences between both groups in the amplitude of the deep Peroneal CMAP (p<0.0001), the minimum, mean and maximum F-waves latencies (p<0.0001), and persistence (p≃0.014). All these parameters were significantly correlated with severity of radiculopathy. We found that the F-wave latencies and chronodispersion were progressively larger and persistent and the amplitude of motor conduction studies was lower. The factor that showed higher sensitivity in the diagnosis of this condition was the F-wave maximum latency, 31.25%, and the less sensitive was the persistence, changed only in 9.34% of individuals. Taking into account all the parameters evaluated in the Fresponses we achieved a global sensitivity of this technique to 42.19%. With this research we concluded that the nerve conduction studies and F-responses may be useful as a supplement in the evaluation of lumbar radiculopathy, presenting a considerable sensitivity to this pathology. One should not limit the study of this technique for the evaluation of minimal F-wave latencies, but always include all other parameters, thereby increasing its sensitivity. These techniques should be included in the L5 radiculopathies studies.
The lumbar radiculopathy refers to a pathological process involving spinal nerve roots, causing radicular symptoms in the lower limbs. F-responses are late waves that come from recurrent discharges of motor neurons depolarized antidromically, which may be useful in evaluating root lesions. The goal of this study is to evaluate the use of nerve conduction studies and Fresponses of the Peronial nerve in the diagnosis of L5 radiculopathy and its correlation with the degree of severity. We studied 47 subjects suffering from L5 radiculopathy, compared with a control group consisting of 28 healthy individuals. We evaluate the amplitudes of the deep Peroneal nerve CMAP, the superficial Peroneal SNAP, F-responses in terms of minimal, mean, maximum latencies, chronodispersion and persistence. In order to classify the severity of lesion of the root we also performed an electromyographic evaluation. Were noticed significant differences between both groups in the amplitude of the deep Peroneal CMAP (p<0.0001), the minimum, mean and maximum F-waves latencies (p<0.0001), and persistence (p≃0.014). All these parameters were significantly correlated with severity of radiculopathy. We found that the F-wave latencies and chronodispersion were progressively larger and persistent and the amplitude of motor conduction studies was lower. The factor that showed higher sensitivity in the diagnosis of this condition was the F-wave maximum latency, 31.25%, and the less sensitive was the persistence, changed only in 9.34% of individuals. Taking into account all the parameters evaluated in the Fresponses we achieved a global sensitivity of this technique to 42.19%. With this research we concluded that the nerve conduction studies and F-responses may be useful as a supplement in the evaluation of lumbar radiculopathy, presenting a considerable sensitivity to this pathology. One should not limit the study of this technique for the evaluation of minimal F-wave latencies, but always include all other parameters, thereby increasing its sensitivity. These techniques should be included in the L5 radiculopathies studies.
Description
Keywords
Radiculopatia L5 Resposta-F Eletromiografia Estudos de condução nervosa Nervo peronial L5 radiculopathy F-Response Electromyography Nerve conduction studies Peroneal nerve
Citation
Publisher
Instituto Politécnico do Porto. Escola Superior de Tecnologia da Saúde do Porto