Shields Christopher B, Ping Zhang Yi, Shields Lisa B E, Burke Darlene A, Glassman Steven D
Kentucky Spinal Cord Injury Research Center, University of Louisville School of Medicine, Louisville, KY 40202, USA.
Surg Neurol. 2006 Nov;66(5):475-83; discussion 483. doi: 10.1016/j.surneu.2006.04.009.
The neurologic examination serves as the optimal method to record the level of spinal cord injury (SCI). However, this test is subject to interexaminer variability. To address this shortcoming, we describe a technique that uses transcranial magnetic motor-evoked potentials (tcMMEPs) and dermatomal somatosensory-evoked potentials (d-SSEPs) to more accurately measure the precise level of SCI.
Two groups of subjects were studied: (1) complete cervical SCI (n = 10) and (2) neurologically intact volunteers (n = 10). Two additional patients were evaluated: one with a cervical central spinal cord syndrome and another with a head injury with a suspected cervical SCI. Each subject underwent upper extremity tcMMEPs and d-SSEPs.
Transcranial magnetic motor-evoked potentials were elicited from all upper limb myotomes (C4-T1, bilaterally) in neurologically intact volunteers (20 sides). The level of injury was determined using tcMMEPs by observing the lowest level of measurable response. The level of injury obtained using tcMMEPs was the same as that determined by neurologic examination in 13 (65%) of the 20 sides. In 7 sides, tcMMEP responses were obtained 1 level lower than that assessed by physical examination. Dermatomal somatosensory-evoked potentials were obtained from all dermatomes of volunteers tested in the laboratory compared with only 5 of the 9 patients with SCI who underwent d-SSEP testing.
Testing using tcMMEPs provides an objective supplement to the neurologic examination after acute cervical SCI. Dermatomal somatosensory-evoked potentials were of limited value in determining the level of cervical SCI.
神经学检查是记录脊髓损伤（SCI）水平的最佳方法。然而，这项检查存在检查者之间的差异。为了解决这一缺点，我们描述了一种使用经颅磁运动诱发电位（tcMMEPs）和皮节体感诱发电位（d-SSEPs）来更准确测量SCI确切水平的技术。
研究了两组受试者：（1）完全性颈髓损伤患者（n = 10）和（2）神经功能正常的志愿者（n = 10）。另外评估了两名患者：一名患有颈中央脊髓综合征，另一名头部受伤并疑似颈髓损伤。每位受试者均接受了上肢tcMMEPs和d-SSEPs检查。
在神经功能正常的志愿者（20侧）中，从所有上肢肌节（双侧C4-T1）引出了经颅磁运动诱发电位。通过观察可测量反应的最低水平，使用tcMMEPs确定损伤水平。在20侧中的13侧（65%），使用tcMMEPs获得的损伤水平与神经学检查确定的水平相同。在7侧中，tcMMEP反应比体格检查评估的水平低1个节段。与仅9名接受d-SSEP检查的脊髓损伤患者中的5名相比，在实验室对志愿者的所有皮节进行了皮节体感诱发电位检查。
使用tcMMEPs进行检查为急性颈髓损伤后的神经学检查提供了客观补充。皮节体感诱发电位在确定颈髓损伤水平方面价值有限。
