Mazur Marcus D, White Andrea, McEvoy Sara, Bisson Erica F
From the Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City.
Spine (Phila Pa 1976). 2014 Jun 15;39(14):1113-20. doi: 10.1097/BRS.0000000000000358.
Prospective cohort study.
To assess the correlation between central motor conduction time (CMCT) and various subjective and objective clinical assessment measures in patients undergoing decompressive surgery for cervical spondylotic myelopathy (CSM).
CSM can cause a spectrum of neurological deficits among individuals. Subjective clinical assessments of disease severity may lack the sensitivity of objective tests. Transcranial magnetic stimulation provides objective electrophysiological data on the integrity of the corticospinal tracts, which may be useful for monitoring disease progression or neurological improvement after surgery.
Patients undergoing surgical decompression for CSM underwent subjective and objective testing before surgery and at 1, 3, 6, and 12 months after surgery. Subjective measures included modified Japanese Orthopaedic Association score, Neck Disability Index, Nurick grade, and visual analogue scale score. Objective measures included CMCT as measured using transcranial magnetic stimulation, the 10-m walk test, the 9-hole peg task, and the grip and release test. Primary outcome was the correlation between CMCT and subjective or objective measures at preoperative and postoperative time points. Secondary outcome was the correlation between preoperative CMCT and performance in subjective or objective testing after surgical intervention.
Improvement in both subjective and objective measures was observed after surgery. CMCT correlated with other objective measures (10-m walk test, 9-hole peg task, and grip and release test) both at baseline and after decompressive surgery in these 17 patients with CSM. Patients with high baseline CMCTs were associated with poor performance on the 10-m walk test, 9-hole peg task, and grip and release test. Modified Japanese Orthopaedic Association score correlated with CMCT at baseline but not after surgical intervention. CMCT was not associated with other subjective measures, such as Neck Disability Index, Nurick grade, and visual analogue scale score, at preoperative or postoperative time points.
CMCT as measured by transcranial magnetic stimulation is a responsive objective assessment of CSM. It can be used to monitor disease severity and neurological function before and after surgical intervention. Prolonged baseline CMCT may be associated with worse surgical outcomes.
前瞻性队列研究。
评估脊髓型颈椎病（CSM）减压手术患者的中枢运动传导时间（CMCT）与各种主观和客观临床评估指标之间的相关性。
CSM可导致个体出现一系列神经功能缺损。疾病严重程度的主观临床评估可能缺乏客观测试的敏感性。经颅磁刺激可提供有关皮质脊髓束完整性的客观电生理数据，这可能有助于监测疾病进展或手术后的神经功能改善。
接受CSM手术减压的患者在手术前以及手术后1、3、6和12个月接受主观和客观测试。主观指标包括改良日本骨科协会评分、颈部功能障碍指数、Nurick分级和视觉模拟量表评分。客观指标包括使用经颅磁刺激测量的CMCT、10米步行试验、9孔插钉试验以及抓握和松开试验。主要结局是术前和术后时间点CMCT与主观或客观指标之间的相关性。次要结局是术前CMCT与手术干预后主观或客观测试表现之间的相关性。
手术后观察到主观和客观指标均有改善。在这17例CSM患者中，CMCT在基线时以及减压手术后均与其他客观指标（10米步行试验、9孔插钉试验以及抓握和松开试验）相关。基线CMCT较高的患者在10米步行试验、9孔插钉试验以及抓握和松开试验中的表现较差。改良日本骨科协会评分在基线时与CMCT相关，但在手术干预后不相关。在术前或术后时间点，CMCT与其他主观指标，如颈部功能障碍指数、Nurick分级和视觉模拟量表评分均无关。
经颅磁刺激测量的CMCT是对CSM的一种敏感的客观评估。它可用于监测手术干预前后的疾病严重程度和神经功能。基线CMCT延长可能与较差的手术结局相关。
2级。
