Lo Y L, Chan L L, Lim W, Tan S B, Tan C T, Chen J L T, Fook-Chong S, Ratnagopal P
Department of Neurology, Singapore General Hospital, Singapore.
Spine (Phila Pa 1976). 2004 May 15;29(10):1137-45. doi: 10.1097/00007632-200405150-00017.
STUDY DESIGN: A prospective study over a 3.5-year period involving transcranial magnetic stimulation and magnetic resonance imaging. OBJECTIVES: To assess the correlation of transcranial magnetic stimulation and magnetic resonance imaging in cervical spondylotic myelopathy qualitatively and statistically. SUMMARY OF BACKGROUND DATA: Cervical spondylotic myelopathy presents with different degrees of cord compression, which can be assessed by magnetic resonance imaging. There are no large studies correlating transcranial magnetic stimulation and magnetic resonance imaging findings in this condition. METHODS: A total of 141 patients with a clinical diagnosis of cervical spondylotic myelopathy were prospectively studied over a 3.5-year period. They were classified into Groups 1 to 4 based on severity of cervical cord changes on magnetic resonance imaging. All had transcranial magnetic stimulation and central motor conduction time measurements within 2 months of the magnetic resonance imaging study. RESULTS: Twenty-eight, 49, 28, and 36 patients were classified into Groups 1 to 4, respectively. Mean upper limb and lower limb central motor conduction times correlated with the severity of magnetic resonance cord compression. The absence of central motor conduction time abnormalities correlated reliably with the absence of cervical cord impingement as in Group 1. Statistically significant right left difference in central motor conduction time in the lower limbs was seen between Groups 1 (no cord changes) and Group 2 (mild cord impingement). Eight other patients with diagnoses other than cervical spondylotic myelopathy all showed central motor conduction time abnormalities. The sensitivity and specificity for transcranial magnetic stimulation for differentiating the presence from absence of magnetic resonance imaging cord abnormality were 100% and 84.8%, respectively. CONCLUSIONS: Transcranial magnetic stimulation showed excellent correlation with magnetic resonance imaging findings and can be considered as an effective technique for screening patients for cervical cord abnormalities before magnetic resonance imaging in the clinical setting. The findings in this study have relevant implications in the pathophysiology, management, and health costs of cervical spondylotic myelopathy.
研究设计：一项为期3.5年的前瞻性研究，涉及经颅磁刺激和磁共振成像。 目的：定性和统计评估经颅磁刺激与磁共振成像在脊髓型颈椎病中的相关性。 背景数据总结：脊髓型颈椎病表现为不同程度的脊髓受压，可通过磁共振成像进行评估。目前尚无大型研究将经颅磁刺激与磁共振成像结果在这种情况下进行关联。 方法：在3.5年的时间里，对141例临床诊断为脊髓型颈椎病的患者进行了前瞻性研究。根据磁共振成像显示的颈髓变化严重程度，将他们分为1至4组。所有患者在磁共振成像研究后2个月内均接受了经颅磁刺激和中枢运动传导时间测量。 结果：分别有28例、49例、28例和36例患者被分为1至4组。上肢和下肢中枢运动传导时间的平均值与磁共振脊髓受压的严重程度相关。如第1组所示，中枢运动传导时间无异常与无颈髓受压可靠相关。在第1组（无脊髓变化）和第2组（轻度脊髓受压）之间，下肢中枢运动传导时间存在统计学上显著的左右差异。另外8例诊断不是脊髓型颈椎病的患者均显示中枢运动传导时间异常。经颅磁刺激区分磁共振成像脊髓异常有无的敏感性和特异性分别为100%和84.8%。 结论：经颅磁刺激与磁共振成像结果显示出极好的相关性，在临床环境中，可被视为在磁共振成像之前筛查颈髓异常患者的有效技术。本研究结果对脊髓型颈椎病的病理生理学、治疗和医疗成本具有相关意义。
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