Department of Orthopedic Surgery, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan.
J Spinal Cord Med. 2021 Jul;44(4):541-548. doi: 10.1080/10790268.2019.1617920. Epub 2019 Jun 10.
The correlation between the progression of spinal cord lesions using spinal cord evoked potentials (SCEPs) and neurological findings are unclear. The purpose is to electrophysiologically evaluate relative vulnerability of spinal cord in patients with compressive cervical myelopathy (CCM) at C4-C5 intervertebral level using SCEPs and correlate the progression of spinal cord lesions with neurological findings. Retrospective study. Yamaguchi University Hospital. 36 patients. SCEPs following median nerve stimulation (MN-SCEPs), ulnar nerve stimulation (UN-SCEPs), transcranial electric stimulation (TCE-SCEPs), and spinal cord stimulation (SC-SCEPs) were intraoperatively recorded. MN-SCEPs are mediated by posterior horns (4, 5 layers), UN-SCEPs by the Burdach tract, TCE-SCEPs by the lateral corticospinal tract, and SC-SCEPs by the Goll tract. We evaluated the neurological findings (numbness, tactile sense and pain sense in the C6 area, tactile sense in the lower extremities, and triceps tendon reflex [TTR]). The incidence of electrophysiological and clinical abnormalities decreased in the order of UN-SCEPs (100%), TCE-SCEPs (94.4%), MN-SCEPs (77.8%), and SC-SCEPs (69.4%), and in the order of numbness (100%), pain sense (97.2%), TTR (91.7%), tactile sense in the C6 area (83.3%), and tactile sense in the lower extremities (70.0%), respectively. The relative vulnerability of spinal cord occurred in the order of the Burdach tract, the lateral corticospinal tract, posterior horns (4, 5 layers), and the Goll tract in most patients with CCM at the C4-C5 intervertebral level.
脊髓诱发电位(SCEPs)检测到的脊髓病变进展与神经学发现之间的相关性尚不清楚。本研究旨在通过 SCEPs 对 C4-C5 颈椎水平的压迫性颈髓病(CCM)患者的脊髓相对易损性进行电生理评估,并将脊髓病变的进展与神经学发现相关联。回顾性研究。日本山口大学医院。36 例患者。正中神经刺激(MN-SCEPs)、尺神经刺激(UN-SCEPs)、经颅电刺激(TCE-SCEPs)和脊髓刺激(SC-SCEPs)术中记录 SCEPs。MN-SCEPs 由后角(4、5 层)介导,UN-SCEPs 由 Burdach 束介导,TCE-SCEPs 由外侧皮质脊髓束介导,SC-SCEPs 由 Goll 束介导。我们评估了神经学发现(C6 区麻木、触觉和痛觉、下肢触觉和三头肌腱反射[TTR])。电生理和临床异常的发生率依次为 UN-SCEPs(100%)、TCE-SCEPs(94.4%)、MN-SCEPs(77.8%)和 SC-SCEPs(69.4%),麻木(100%)、痛觉(97.2%)、TTR(91.7%)、C6 区触觉(83.3%)和下肢触觉(70.0%)。在 C4-C5 颈椎水平的 CCM 患者中,脊髓的相对易损性依次为 Burdach 束、外侧皮质脊髓束、后角(4、5 层)和 Goll 束。
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