The Diagnostic Role of Adding the Hoffman Reflex Study for L5 Radiculopathy in the Electrodiagnostic Laboratory
Condition: Radiculopathy; Hoffman's Reflex
MeSH terms: Radiculopathy; Reflex, Abnormal
Study type: Observational

Summary: 
      The H-reflex is one of the most popular topics in reflexology and one of the late responses
      involved in routine nerve conduction studies in the electromyography (EMG) laboratory. The
      H-reflex is generally recorded from the gastrocnemius-soleus muscles (tibial H-reflex) by
      stimulating the tibial nerve in the lower extremity. Tibial H-reflex is a sensitive
      measurement for examining S1 radiculopathy. Although there are plenty of studies related to
      the Soleus muscle registered H-reflex in S1 radiculopathy in the literature, there is no
      study in which the H-reflex is used in L5 muscles in diagnosing L5 radiculopathies. The aim
      of this study is to investigate the effectiveness of the H-reflex by using a different method
      in the distinction between L5 and S1 radiculopathies.
    

Detailed description: 
      The H-reflex is one of the most popular topics in reflexology and one of the late responses
      involved in routine nerve conduction studies in the electromyography (EMG) laboratory. The
      H-reflex is generally recorded from the gastrocnemius-soleus muscles (tibial H-reflex) by
      stimulating the tibial nerve in the lower extremity. Tibial H-reflex is a sensitive
      measurement for examining S1 radiculopathy.

      Hoffman et al. developed a method for simultaneously evaluating the H-reflex obtained from
      different muscles with single peripheral nerve stimulation. With this method, H-reflex
      measurement can be done in three leg muscles, including the tibialis anterior, peroneus
      longus, and soleus with sciatic nerve stimulation. Thus, the L5 and S1 roots can be evaluated
      separately with a single stimulation.

      Although there are plenty of studies related to the Soleus muscle registered H-reflex in S1
      radiculopathy in the literature, there is no study in which the H-reflex is used in L5
      muscles in diagnosing L5 radiculopathies. The aim of this study is to investigate the
      effectiveness of the H-reflex by using a different method in the distinction between L5 and
      S1 radiculopathies.

      The H-reflex was evaluated simultaneously using the method developed by Hoffman et al. using
      superficial recording electrodes in a 3-channel way from the Tibialis anterior, Peroneus
      Longus, and Soleus muscles.

      Latency was recorded when the maximum H-reflex amplitude was obtained. The onset H-reflex
      latency was marked and measured for each muscle. The patients were evaluated according to EMG
      and magnetic resonance imaging findings. The latency of the H-reflex was compared with the
      contralateral extremity in each group.
    

Observational model: Cohort
Time perspective: Cross-Sectional
Sampling method: Non-Probability Sample
Study population: 
        A total of 58 patients admitted applied to the outpatient clinics due to unilateral
        radicular back pain and who had L5 or S1 root compression in magnetic resonance imaging
        (MRI) participated in this study.
      
Keywords: Electrodiagnosis