Lumbar paraspinal mapping EMG has standardized and validated the use of EMG, showing it superior to imaging in many ways. However, no valid cervical technique has been proposed. This study devises an anatomically valid, quantifiable technique for Cervical Paraspinal Mapping needle EMG.
Papers and texts regarding cervical paraspinal anatomy and cervical paraspinal EMG techniques were reviewed to determine possible innervation patterns of the cervical paraspinal muscles. A technique was designed based on this information and clinical experience.
We found no study that specifies anatomical insertion site, angle, extent of insertion, standardization of scoring, and range of norms. Anatomical evidence suggests that the single-root innervated multifidus originates at any given cervical spinous process and inserts in a multipennate manner at 2, 3, 4, 5, 6, and sometimes 7 transverse processes below. This occurs in a small space between the spinous process and transverse process and deep to large superficial muscles innervated by C2, 3, and 4.
The Cervical Paraspinal Mapping technique was proposed:
Six scores are obtained as follows, then summed. At C5, C7, and T2 spinous process palpate a location 2 cm lateral to midline. At each of these locations insert a monopolar needle at a 60o depth, aimed at midline, until contact with bone. Withdraw, orient the needle 45o caudal, insert at 60o depth to bone contact. Insertions should be in ½ cm steps, eliciting any positive waves or fibrillations. These are scored from 0 (no fibrillations lasting more than 1 second) to 4+ (fibrillations occlude baseline. Total for 6 locations and findings at each level are reported.
This Cervical Paraspinal Mapping technique has been found practicable in clinical situations, not reported here. Future work must develop norms, assess sensitivity and specificity for radiculopathy, and compare to imaging standards. The impact on treatment and outcomes needs to be evaluated.