Localizing the Lesion

By | May 22, 2015

This X Ray show severe straightening of the cervical spine, which is suggestive of inflammation and pain.  The exact cause cannot be determined from this anatomic test.

This X Ray show severe straightening of the cervical spine, which is suggestive of inflammation and pain. The exact cause cannot be determined from this anatomic test.

I have been meaning to do a blog on the value of physiologic testing for some time now and Tuesday the perfect patient walked into the Burbank office of Schlesinger Pain Centers. Marcy Peters (not her real name) is an 85-year-old woman whom I have been treating for radicular back pain and neck pain for many years. Of late she has had persistent right arm pain with some weakness, especially in her hand. I have given her a couple of interlaminar cervical epidural steroid injections (IL CESI) without much effect. The MRI of her cervical spine has a washboard appearance with moderate sized disc protrusions at each level, making it difficult to tell which if any of the discs is the major source of her pain and weakness.. In preparation for sending Margie to a surgeon[1] I asked for a neurology consultation and an electromyogram and nerve conduction velocity test (EMG/NCV) in the hope that it would help localize which of the anatomic abnormalities (disc protrusions) was causing her pain.

To be continued…

[1] You will remember that we have said that spinal surgery is most effective if the problem can be accurately localized preoperatively allowing a very small and focused procedure.


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