Clinical and electrophysiological appraisal of the significance of radicular injury in back pain.
Clinical electrophysiological studies were analysed in 60 consecutive patients with back pain with or without other evidence for a radiculopathy. These studies included needle EMG of relevant limb and paraspinal muscles as well as F responses and H reflexes recorded from the soleus muscle. Segmental denervation was found in 29 of the 60 patients. In 57 patients, abnormal slowing of the F response was present in 27, either unilaterally (25) or bilaterally (two). In 18 of 47 patients with H reflex studies, the H reflex was either unilaterally absent (12), asymmetrically prolonged (five), or bilaterally prolonged (one). Statistically significant (P less than 0.05) associations were found between (1) abnormalities of H reflexes and F responses, (2) F response slowing and radicular injury shown by EMG, (3) segmentally consistent radiographic defects and abnormalities of both H reflexes and F responses, and (4) depressed Achilles reflexes as well as sensory loss and abnormal H reflexes. No significant association, however, was present between abnormalities of EMG, F responses, or H reflexes and pain radiation by history or positive straight leg-raising tests. These data suggest that pain in radicular syndromes is related to the functioning of smaller afferent fibres.