Jutzeler Catherine R, Ulrich Anett, Huber Barbara, Rosner Jan, Kramer John L K, Curt Armin
1 ICORD, University of British Columbia , Vancouver, British Columbia, Canada .
2 Spinal Cord Injury Center, University Hospital Balgrist , Zurich, Switzerland .
J Neurotrauma. 2017 Jun 15;34(12):2045-2053. doi: 10.1089/neu.2016.4891. Epub 2017 Apr 7.
The aim of this study was to reveal the sensitivity and responsiveness of contact heat evoked potentials (CHEPs) to assess cervical spondylotic myelopathy (CSM). A total of 81 patients with clinically and radiologically confirmed spinal cord compression were reviewed. All patients underwent full clinical examinations with combined recordings of segmental CHEPs and somatosensory evoked potentials (dSSEPs) compared with healthy controls. Cross-sectional area, maximal canal compression, and maximal spinal cord compression were determined based on T2-weighted MRI. CHEPs exhibited the highest sensitivity (∼ 95%) to disclose at-level impairments in CSM patients. Normally appearing rostral segments above the level of lesion were impaired in 17% of patients. Comparatively, dSSEPs were less affected (24%) and predominantly impaired at and below the level of CSM. Longitudinal evaluation revealed that CHEPs became progressively impaired in parallel with clinical deterioration. CHEPs were sensitive to CSM, revealing evidence of impaired neurophysiology at and below the radiographic level of stenosis. The changes observed above the level of CSM suggest neurophysiological deficits beyond the focally damaged area. Deteriorating CHEPs were observed in a cohort of patients with worsening neurological symptoms, indicating their responsiveness to track CSM. The present study highlights the value of incorporating CHEPs into the diagnosis and prognosis of CSM.
本研究的目的是揭示接触热诱发电位（CHEPs）评估脊髓型颈椎病（CSM）的敏感性和反应性。回顾了81例经临床和影像学确诊为脊髓受压的患者。所有患者均接受了全面的临床检查，并将节段性CHEPs和体感诱发电位（dSSEPs）的联合记录与健康对照进行比较。基于T2加权MRI确定横截面积、最大椎管压迫和最大脊髓压迫。CHEPs对揭示CSM患者的节段性损伤表现出最高的敏感性（约95%）。在17%的患者中，病变水平以上正常出现的延髓段受损。相比之下，dSSEPs受影响较小（24%），主要在CSM水平及以下受损。纵向评估显示，CHEPs随着临床恶化逐渐受损。CHEPs对CSM敏感，在影像学狭窄水平及以下显示神经生理学受损的证据。在CSM水平以上观察到的变化表明局灶性损伤区域以外存在神经生理缺陷。在一组神经症状恶化的患者中观察到CHEPs恶化，表明它们对追踪CSM有反应性。本研究强调了将CHEPs纳入CSM诊断和预后评估的价值。
