Cervical root compression monitoring by flexor carpi radialis H-reflex in healthy subjects.

Abstract

One-group, pretest-postest experimental research with repeated measures. To determine the effect of head postural modification on the flexor carpi radialis H-reflex in healthy subjects. H-reflex testing has been reported to be useful in evaluating and treating patients with lumbosacral and cervical radiculopathy. The idea behind this technique is that postural modification can cause further H-reflex inhibition, indicating more compression of the impinged nerve root, or recovery, indicating decompression of the root. Such assumptions cannot be supported unless the influence of normal head postural modification on the H-reflex in healthy subjects is studied. Twenty-two healthy subjects participated in this study (14 men, 8 women; mean age, 39 +/- 9 years). The median nerve of the subjects at the cubital fossa was electrically stimulated (0.5 msec; 0.2 pulses per second [pps] at H-max), whereas the flexor carpi radialis muscle H-reflex was recorded by electromyography. The H-reflexes were recorded after the subject randomly maintained the end range of head-forward flexion, backward extension, rotation to the right and the left, lateral bending to the right and the left, retraction and protraction. These were compared with the H-reflex recorded during comfortable neutral positions. Data were recorded after the subject maintained the position for 30 seconds, to avoid the effect of dynamic postural modification on the H-reflex. Four traces were recorded in each position. During recording, the H-reflex was monitored by the M-response to avoid any changes in the stimulation-recording condition. Repeated multivariate analysis of variance was used to evaluate the significance of the difference among the H-reflex, amplitude, and latency, in various head positions. The H-reflex amplitude showed statistically significant changes (P < 0.001) with head postural modification. All head positions, except flexion, facilitated the H-reflex. Extension, lateral bending, and rotation toward the side of the recording produced higher reflex facilitation than the other positions. These results indicate that H-reflex changes may be caused by spinal root compression-decompression mechanisms. It may also indicate that relative spinal root decompression occurs in most head-neck postures except forward flexion. Head postural modification significantly influences the H-reflex amplitude but not the latency. This indicates that the H-reflex is a more sensitive predictor of normal physiologic changes than are latencies. The H-reflex modulation in various head positions may be-caused by relative spinal root compression-decompression mechanisms.