Sarcouncil Journal of Medicine and Surgery

Abstract: Objective: To assess the diagnostic usefulness of the combination of electromyography (EMG) with other complementary diagnostic tests, such as magnetic resonance imaging (MRI), high-resolution ultrasonography, genetic testing, and intraoperative neuro-monitoring in a group of children with neurological and surgical conditions. Study Design: cross-sectional study during a 12-month follow-up (January 2025 – January 2026) at the pediatric department in different hospitals in Iraq. A consecutive series of 127 children between the ages of 0 and 17 on whom EMG was performed as part of their diagnostic workup for suspected neuromuscular disease.127 children aged 0-17 years who underwent EMG as part of their diagnostic workup for suspected neuromuscular disease. Outcomes: The highest diagnostic accuracy (94.5%, 95% CI 89.0–97.8%) and inter-modality concordance (κ = 0.84) was obtained with the use of EMG combined with ≥2 complementary modalities. The surgical subgroup (n = 53) showed a greater intra-operative concordance (89.5% vs 58.3%), a lower rate of revision surgery (5.3% vs 25.0%), and significant improvements in functional recovery at 12 months with multi-modal pre-operative assessment. The use of EMG + ≥2 modalities was the strongest independent predictor of correct diagnosis when evaluated on multivariable logistic regression (OR 6.82; 95% CI 2.77–16.80; p < 0.001). Conclusion: The multi-modal diagnostic strategy combining EMG and MRI, ultrasonography, genetic testing, and/or intraoperative neuromonitoring (IONM) leads to significant improvement in diagnostic accuracy and surgical results in paediatric neurology and neurosurgery with neuromuscular diseases.