Transcranial magnetic stimulation screening for cord compression in cervical spondylosis

Lo, Yew Long; Chan, Ling‐Ling; Lim, Winston Eng Hoe; Tan, Seck Guan; Tan, Chao; Chen, J.L.T.; Fook‐Chong, S.; Ratnagopal, Pavanni

doi:10.1016/j.jns.2005.12.002

Cited by 22 publications

(19 citation statements)

References 27 publications

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“…Recently, MEP has been shown to correlate closely with the degree of MRI-detected spondylotic cervical cord compression in patients with clinical diagnosis of possible cervical myelopathy [17]. In contrast, EMG abnormalities interpreted as anterior horn cell lesion signs became closely correlated with the presence of symptomatic radiculopathy and were excluded from the final prediction model as a non-independent variable.…”

Section: Discussionmentioning

confidence: 99%

Presymptomatic spondylotic cervical myelopathy: an updated predictive model

et al. 2008

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Spondylotic cervical cord compression detected by imaging methods is a prerequisite for the clinical diagnosis of spondylotic cervical myelopathy (SCM). Little is known about the spontaneous course and prognosis of clinically ''silent'' presymptomatic spondylotic cervical cord compression (P-SCCC). The aim of the present study was to update a previously published model predictive for the development of clinically symptomatic SCM, and to assess the early and late risks of this event in a larger cohort of P-SCCC subjects. A group of 199 patients (94 women, 105 men, median age 51 years) with magnetic resonance signs of spondylotic cervical cord compression, but without clear clinical signs of myelopathy, was followed prospectively for at least 2 years (range 2-12 years). Various demographic, clinical, imaging, and electrophysiological parameters were correlated with the time for the development of symptomatic SCM. Clinical evidence of the first signs and symptoms of SCM within the follow-up period was found in 45 patients (22.6%). The 25th percentile time to clinically manifested myelopathy was 48.4 months, and symptomatic SCM developed within 12 months in 16 patients (35.5%). The presence of symptomatic cervical radiculopathy and electrophysiological abnormalities of cervical cord dysfunction detected by somatosensory or motor-evoked potentials were associated with time-to-SCM development and early development (B12 months) of SCM, while MRI hyperintensity predicted later ([12 months) progression to symptomatic SCM. The multivariate predictive model based on these variables correctly predicted early progression into SCM in 81.4% of the cases. In conclusion, electrophysiological abnormalities of cervical cord dysfunction together with clinical signs of cervical radiculopathy and MRI hyperintensity are useful predictors of early progression into symptomatic SCM in patients with P-SCCC. Electrophysiological evaluation of cervical cord dysfunction in patients with cervical radiculopathy or back pain is valuable. Meticulous follow-up is justified in high-risk P-SCCC cases.

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Section: Discussionmentioning

confidence: 99%

Presymptomatic spondylotic cervical myelopathy: an updated predictive model

et al. 2008

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“…20 In cases of inconsistency of clinical symptoms and morphologic findings, neurophysiological methods may aid in the decision process, 1 particularly needle EMG and evoked potentials, that reflect anterior horn cell, dorsal column, and corticospinal tract impairment, respectively. Dysfunction of long afferent and efferent spinal pathways because of chronic compression in CCSM has previously been described, 2,4,[21][22][23] however, reports about spinothalamic tract involvement in CCSM are scarce. 10 SEP and MEP abnormalities are frequent in advanced cases of CCSM, but may even serve as a predictive factor in preclinical "silent" cases.…”

Section: Discussionmentioning

confidence: 98%

“…2 Upper and lower limb SEPs correlated well with the severity of CCSM, 4,21,22 yet MEPs had a higher sensitivity and specificity for spinal cord abnormalities as based on MRI. 4,23 The median nerve SEP component N13 reflects postsynaptic activity in the dorsal horn in response to non-noxious input from fast-conducting large-diameter fibers and is regarded as a reliable parameter of cervical gray matter dysfunction in syringomyelia and cervical myelopathy. 24,25 N13 may be abnormal despite normal cortical responses.…”

Section: Discussionmentioning

confidence: 99%

Cutaneous Silent Periods in the Assessment of Mild Cervical Spondylotic Myelopathy

̌Sťetkářová¹,

Kofler²

2009

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We confirm the value of neurophysiological evaluation of CCSM. MEPs were more frequently abnormal than SEPs. CSP abnormalities were almost equally sensitive as upper limb MEPs, and were highly associated with spinothalamic dysfunction. The high correlation of CSP abnormalities with corticospinal tract dysfunction suggests supraspinal influence on CSPs. Our findings corroborate the utility of CSP testing in the comprehensive assessment of intramedullary spinal cord dysfunction in CCSM.

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“…In particular, there is a correlation between the CMCT prolongation and the clinical disability [12,16]. Moreover, CMCT was found to be more prolonged in patients who had more severe cervical spinal cord compression as determined by MRI analysis [17]. Because of this delayed CMCT, it is suggested that CMCT prolongation is primarily due to corticospinal conduction block, rather than conduction delay [18][19][20].…”

Section: Discussionmentioning

confidence: 99%

Quantitative assessment of myelopathy patients using motor evoked potentials produced by transcranial magnetic stimulation

et al. 2009

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Motor evoked potentials (MEPs) study using transcranial magnetic stimulation (TMS) may give a functional assessment of corticospinal conduction. But there are no large studies on MEPs using TMS in myelopathy patients. The purpose of this study is to confirm the usefulness of MEPs for the assessment of the myelopathy and to investigate the use of MEPs using TMS as a screening tool for myelopathy. We measured the MEPs of 831 patients with symptoms and signs suggestive of myelopathy using TMS. The MEPs from the abductor digiti minimi (ADM) and abductor hallucis (AH) muscles were evoked by transcranial magnetic brain stimulation. Central motor conduction time (CMCT) is calculated by subtracting the peripheral conduction time from the MEP latency. Later, 349 patients had surgery for myelopathy (operative group) and 482 patients were treated conservatively (nonoperative group). CMCTs in the operative group and nonoperative group were assessed. MEPs were prolonged in 711 patients (86%) and CMCTs were prolonged in 493 patients (59%) compared with the control patients. CMCTs from the ADM and AH in the operative group were significantly more prolonged than that in the nonoperative group. All patients in the operative group showed prolongation of MEPs or CMCTs or multiphase of the MEP wave. MEP abnormalities are useful for an electrophysiological evaluation of myelopathy patients. Moreover, MEPs may be effective parameters in spinal pathology for deciding the operative treatment.

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Transcranial magnetic stimulation screening for cord compression in cervical spondylosis

Cited by 22 publications

References 27 publications

Presymptomatic spondylotic cervical myelopathy: an updated predictive model

Presymptomatic spondylotic cervical myelopathy: an updated predictive model

Cutaneous Silent Periods in the Assessment of Mild Cervical Spondylotic Myelopathy

Quantitative assessment of myelopathy patients using motor evoked potentials produced by transcranial magnetic stimulation

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