Abstract
Objectives: Defining the principles and tactics of differential use of Neurophysiological (NPh) methods in cervical spondilotic myelopathy (CSM) diagnosis.Materials and methods. Analysis of the clinical and NPh examination data of 160 patients (from 31 to 76 years of age) suffering from CSM. The examination techniques used: clinical and neurological; neurovisualizing (MRI, CT, functional spondylography); a set of NPh methods, namely: stimulation electromyography (ENMG) with F-wave recording (188 examinations); needle EMG (105); motor evoked potentials (MEP) (188); somatosensory evoked potentials (SSEP) (50); single fiber EMG with determination of average density of muscle fibers in motor units and reliability of neuromuscular transmission (32).Results. An optimal scheme of the use of NPh diagnostic methods in patients with SCM was worked out and applied. Out of the total of 160 patients examined, 19 (11.9%) had motoneuron involved; 32 (20%) had ALS syndrome at the background of cervical spondylosis; 59 (36.9%) patients had concomitant radiculopathy, etc. The sensitivity of MEP technique in the identification of partial spinal cord compression in cervical spondylosis was confirmed – 134 (83.8%) cases; SSEP – 29 (58%). The clinical example illustrates the role of jitter-analysis in the cases when a subtle differentiation between the motoneuronal disease, ischemic and compression injury of the spinal cord motoneurons is necessary.Conclusions. An optimal scheme of the use of NPh diagnostic methods in patients with CSM was suggested. Due to the use of motor and somatosensory evoked potential techniques, the diagnosis of the spinal cord conduction structures compression and evaluation of the degree of their functional disorders were improved. The use of jitter-analysis allows to increase the information value of NPh diagnosis of the spinal motoneuron involvment, especially at the early stages of the pathological process.
Highlights
In our previous studies [1,2] we analyzed the principles and tactics of the use of neurophysiological (NPh) diagnostic methods on the basis of the NPh examination of 160 patients with cervical spondylotic myelopathy (CSM) in the course of their surgical and non-surgical treatment
The number of published works dedicated to NPh monitoring of the spinal function in patients with compression myelopathy has been steadily increasing lately, which reflects the importance of the problem of diagnosis and treatment of the pathology
The set of NPh methods included: 1) standard stimulating ENMG with F-wave recording (188 tests); 2) needle electromyography (EMG) (105 tests); 3) motor evoked potentials (MEP) to transcranial magnetic stimulation (TMS) and spinal magnetic stimulation (MS) (188); 4) recording of somatosensory evoked potentials to median nerve stimulation (SSEP) (50)
Summary
In our previous studies [1,2] we analyzed the principles and tactics of the use of neurophysiological (NPh) diagnostic methods on the basis of the NPh examination of 160 patients with cervical spondylotic myelopathy (CSM) in the course of their surgical and non-surgical treatment. In spite of significant achievements of neurovisualizing technologies in the objective assessment of the functional condition of segmental and conduction structures of the spinal cord, there still remain unclarified questions, including the theoretical and purely methodological ones. The number of published works dedicated to NPh monitoring of the spinal function in patients with compression myelopathy has been steadily increasing lately, which reflects the importance of the problem of diagnosis and treatment of the pathology. The spinal function disorders, especially that classified as myelopathy, occur in the neurologists’ and neurosurgeons’ clinical practice almost on the daily basis. The cause of spinal cord compression is usually the median protrusion of the intervertebral disc at CV-CVI, CVI-CVII level
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