Die elektromyografische Untersuchung der paraspinalen Muskulatur: Technische Durchführung, Indikationen und diagnostische Aussagekraft

 

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Zusammenfassung

Die elektromyografische Untersuchung der paraspinalen Muskulatur (PM) ist kein fester Bestandteil der neurophysiologischen Abklärung. Bei einigen Fragestellungen stellt die Elektromyografie der PM jedoch eine wichtige Ergänzung zur Untersuchung der Extremitätenmuskulatur dar. Pathologische Spontanaktivität ist in der PM ohne Probleme zu beurteilen. Die Unterscheidung zwischen einem neurogenen und myopathischen Muster bereitet durch die unterschiedliche Potenzialgröße in den verschiedenen Wirbelsäulenabschnitten und die Grenzen der Potenzialregistrierung im Alltag eher Schwierigkeiten. Im höheren Lebensalter kann pathologische Spontanaktivität in der PM gelegentlich vorkommen, ohne dass eine Erkrankung zugrunde liegen muss. Eine Höhenlokalisation des betroffenen Segmentes bei radikulären Läsionen ist aufgrund der polysegmentalen Innervation der PM nicht möglich. Es ist zu beachten, dass die häufiger anzutreffenden Plexusläsionen (Armplexusneuritis, diabetische Plexopathie) auch die Nervenwurzeln einbeziehen können. Schließlich ist das EMG der PM eine wertvolle diagnostische Stütze beim Nachweis eines generalisierten Vorderhornprozesses.

Abstract

Electromyographic examination of the paraspinal muscles is not an inherent part of the electrophysiological investigation. In some situations, however, electromyographic examination of the paraspinal muscles provides important information supplementary to the findings in the muscles of the extremities. Fibrillations and positive sharp waves in the paraspinal muscles are easily assessed. Because of the different sizes of the motor unit potentials of the cervical, thoracal and lumbar paraspinal muscles and the limitations of single motor unit potential analysis in daily routine, the differentiation between a neurogenic and a myopathic process remains difficult. Localisation of the damaged nerve root is not possible, because the paraspinal muscles are innervated polysegmentally. It must be taken into account that lesions of the brachial und lumbar plexus (neuralgic amyptrophy, diabetic amyotrophy) may include the nerve roots. Finally, electromyography of the paraspinal muscles constitutes a useful tool in the diagnosis of anterior horn diseases.

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