#1 Honest 1918-1944 EMG Expert Answers a Colleague’s Questions

Journal of Neurology: James A Charles, MD, FAAN (2013)

James A Charles, MD created a controversy when his article was published in the Journal Neurology. He had pointed out the severe limitation of standard EMG in diagnosing acute radiculopathy. The following is his answer to a particularly upset colleague.

“In the management of spine trauma with radicular symptoms (STRS), EMG and (large fiber) nerve conduction studies (NCS) often have low combined sensitivity and specificity in confirming nerve root injury. Paraspinal studies are non-localizing and can be falsely positive and negative. An honest clinician neurologist or physiatrist who is treating patients with STRS should not have fears that our conclusions will lower their income. However, there are no practice parameters or established guidelines on the clinical utility of EMG/NCS in evaluation of STRS. It appears that unless there is a clinical differential diagnosis including a peripheral neuropathic lesion vs. a root lesion that cannot be resolved with the history, neurological examination, and imaging studies, there is limited evidence to support the use of EMG/NCS in the evaluation, treatment, and prognosis of patients with STRS.”