Aj. Haig, CLINICAL-EXPERIENCE WITH PARASPINAL MAPPING .2. A SIMPLIFIED TECHNIQUE THAT ELIMINATES 3-FOURTHS OF NEEDLE INSERTIONS, Archives of physical medicine and rehabilitation, 78(11), 1997, pp. 1185-1190
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.