1. Validity of diagnostic tools in determining the operation level in multilevel cervical radiculopathy -analysis between physical finding, MRI, and EMG- Byung-Wan Choi, M.D., Kyung-Jin Song, M.D. * Hun Park, M.D. * and Kwang-Bok Lee, M.D. * Departments of Orthopedic Surgery Gwangju Veterans Hospital, Chonbuk National University Hospital * -We have no financial relationships to disclose-

2. The purpose of this study was to verify the usefulness and validity of each diagnostic tools by comparing between physical examination, MRI, and EMG findings in multilevel cervical radiculopathy which performed operative treatment. PURPOSE

3. Demographic Data Degenrative cervical disease 213 cases 36 Cases Conservative management 1 case Additional operation 1 case Polyradiculopathy P/Ex, MRI, EMG Sx improvement YES No

4. Physical Examination

5. EMG Standardized electrophysiological examination - nerve conduction studies (NCS) concentric needle EMG Viking (Nicolet, Wisconsin, USA) Evidence of denervation - the presence of spontaneous activities (fibrillations, positive sharp waves and fasciculations) - long duration polyphasic motor units.

6. MRI MRI(1.5 T Magneton vision, SIEMENS, Elangen, Germany)

7. Gold Standard - Positive: confirmed by operation - Negative: no pathology (in PE, MRI, EMG). the segments not included in operation

8. Method Comparing with operation findings, 1. Sensitivity 2. Specificity 3. Positive predictive value 4. Negative predictive value For comparing between each diagnostic values, Pearson correlation ratio was evaluated.

9. RESULTS

10. Abnormal finding Segments

11. Number of abnormal finding segment

12. Validity of each diagnostic methods

13. Pearson correlation ratio and P-value of each diagnostic methods sensorymotorEMGMRIOP Sensory10.464 p<0.01 0.435 p<0.01 0.359 0.002 0.265 0.027 Motor10.174 0.019 0.391 p<0.01 0.372 p<0.01 EMG10.293 p<0.01 0.300 p<0.01 MRI10.766 p<0.01 OP1

14. MRI was most validated diagnostic study in determining the operation levels of cervical polyradiculopahy. Clinical application of EMG should be make a caution due to the low validity than physical findings. CONCLUSION