CLINICAL-EXPERIENCE WITH PARASPINAL MAPPING .2. A SIMPLIFIED TECHNIQUE THAT ELIMINATES 3-FOURTHS OF NEEDLE INSERTIONS

Objective: To simplify and minimize the quantified needle examination of the paraspinal muscles (paraspinal mapping [PM]) without compromisi ng sensitivity or specificity. Design: Nonrandomized prospective trial . Setting: Electrodiagnostic laboratory of a university spine center a nd of a private practice in a small community. Subjects: One hundred f ourteen consecutive persons referred for electrodiagnosis of spinal or lower extremity disorders who had PM data and 35 previously reported asymptomatic volunteers. Intervention: Abbreviated PM protocols were s imulated by progressively eliminating data from the 45 needle insertio ns of the original PM. Simulations involving 35, 15, 13, and 5 inserti ons resulted in different normal values (95% of asymptomatic volunteer s) and different scores in patients. The resulting reclassification of patients as normal or abnormal was compared with the original protoco l and with clinical data. Main Outcome Measures: False positive and fa lse negative rates of the simulations compared with the original proto col. Results: Abbreviated protocols involving 30, 15, 13, and 5 needle insertions had normal cutoff scores of less than 5, less than 4, less than 3, and less than 2, respectively, with 2%, 2%, 4%, and 8% false positive rates and 3%, 8%, 13%, and 21% false negative rates compared with the original. In many cases clinical information correlated bette r with the abbreviated test results than the original PM. Conclusions: The third protocol compared well with the original PM, and in a limit ed number of patients with imaging studies demonstrated 92% sensitivit y and 92% specificity. By eliminating the iliocostalis, longissimus, a nd lowest multifidus needle explorations, 73% fewer needle insertions were used. We recommend that this new technique, now called ''miniPM,' ' be used in most clinical settings. (C) 1997 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medic ine and Rehabilitation.