Cervical myelopathy: clinical and neurophysiological evaluation

Abstract

The overall frequency of troublesome neck pain is estimated to be about 34%, and it was observed that the frequency of complaints lasting 1 month or longer was higher in women than in men. The prevalence increased with age, with regard to both pain duration and chronic pain. Approximately 14% of a randomly selected population meets the criterion for chronic neck pain: complaints lasting more than 6 months. Epidemiologic data substantiate the importance of morphologic, age-related changes of the cervical spine; however, the incidence and prevalence of cervical myelopathy is not known. It could be that the structural transformation of the intervertebral disc, the uncovertebral processes and the zygapophyseal joints is a process accompanied by disturbed function that ultimately not only induces pain, but can lead to narrowing of spinal canal, with symptoms and signs of cervical myelopathy. For a diagnosis of radicular and myelopathic syndromes, the functional and neurological examination is enhanced by neurophysiological assessment. Electromyography (EMG) performed with needle electrodes is the oldest method for diagnosing nerve root compression and anterior horn cell syndromes, and is claimed to have no false-positive results. For cervical myelopathy, as a routine examination sensory evoked potentials (SEPs) by stimulation of tibial nerve and motor evoked potentials (MEPs) from the upper and lower extremities are recommended.

Degenerative Cervical Myelopathy: Pathophysiology and Current Treatment Strategies

“…The damage to the anterior horn cell or compression of the nerve root can manifest as increased insertional activity, fasciculations, and diminished motor unit recruitment on needle electromyography. Moreover, if the denervation is not fully restored, abnormal spontaneous activity, fibrillations, and positive sharp waves can occur [ 35 ]. Somatosensory evoked potentials, using the median and tibial nerves, can help to assess the degree of central sensory conduction delay or defects in patients with DCM [ 36 ].…”

Anatomy and clinical significance of the uncinate process and uncovertebral joint: A comprehensive review

“…With narrowing of the intervertebral discs the uncinate processes bear a greater load to support the weight of the head. The vertebra above comes to rest on the uncinate processes below which results in remodeling to the flattened and laterally directed configuration (Resnick, 1985;Dvorak, 1998;Prescher, 1998;Dvorak et al, 2003).…”

“…An additional function of the uncinate process is that of bearing the load of the vertebra above (Yamazaki et al, 2003). With age the intervertebral disc dehydrates and thins leading to an increased load being supported by the uncinate processes (Dvorak, 1998;Dvorak et al, 2003). In assuming greater load, the uncinate processes stabilize the vertebra above on the vertebra below.…”

“…Osteophytes that arise from the posterior aspect of the uncinate process project into the intervertebral foramen and encroach on its contents (Philip, 1950;Cave et al, 1955;Boreadis and Gershon-Cohen, 1956;Mcginnis and Eisenbrey, 1964;Houser et al, 1993;Prescher, 1998;Giles, 2000). The cervical nerve roots are closely related to the uncovertebral articulations and can become angulated and mechanically irritated by the intruding uncovertebral osteophyte (Cave et al, 1955;Kiwerski, 1991;Dvorak et al, 2003). In cervical spondylosis, the uncovertebral osteophytes are the most common cause of nerve root compression (Lyon, 1945;Raynor, 1983;Lu et al, 1998;Bozbuga et al, 1999;Ugur et al, 2000;Civelek et al, 2007).…”

Identifying Myelopathy Caused by Thoracic Syringomyelia: A Case Report

“…An evaluation process that incorporates an upper or lower quarter screen can assist with this distinction 2,32 . Traditional upper and lower quarter screens feature a combination of sensibility, myotome, and neurological tests and may involve tests that quickly target functional activities.…”