Bushkov F A, Bzhilyansky M A
Rehabilitation Center «Overcoming», Moscow, Russia.
Zh Nevrol Psikhiatr Im S S Korsakova. 2020;120(4):7-13. doi: 10.17116/jnevro20201200417.
To study the neurophysiological mechanisms of motor deficit in patients with post-traumatic cervical myelopathy.
A retrospective clinical and neurophysiological study was conducted for the period 2008-2018. The study included 190 patients with post-traumatic cervical myelopathy (39 women and 159 men, mean age 27 (21,0; 36,0) years, time after spinal cord injury 3 [1,0; 8,0] years). A spinal cord injury was the cause of cervical myelopathy in 92,5% of the patients. The International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI) was administered at admission and during rehabilitation. A motor nerve conduction study (NCS) was conducted as well. Compound muscle action potentials (CMAP) amplitude and nerve conduction velocity (NCV) in the distal segment of 160 left and 145 right median nerves, 161 left and 151 right tibial nerves, 90 left and 66 right ulnar nerves were recorded. Re-examination (=95 patients) was performed 6 (3,0; 10,0) years after injury. The time between examinations was 2,9 (1,0; 4,0) years. The control groups for the median nerve and the tibial nerve consisted of age- and sex-matched 10 patients with traumatic paraplelegia and 12 healthy subjects, respectively.
In the main group, the SMAP amplitude for the median nerve was 4,1 [1,6; 6,1] mV, NCV 56 [51,0; 61,0] m/s; in the control group the SMAP was 11 [7,50; 16,40] mV (=00), NCV 59 [58,0; 6,0] m/s (=00), in the main group the SMAP amplitude for the tibial nerve was 4,3 [0,65; 7,95] mV, NCV 43 [39,0; 48,0] m/s, in the control group SMAP was 8,4 [6,4; 10,1] mV (=00), NCV 50 [47,0 ; 51,0] m/s (=00). About 20% of patients had severe denervation changes. In patients with clinically complete spinal cord injury, axonal neuropathy (a decrease in SMAP) was more pronounced in all nerves than in incomplete patients, and a decrease in NCV was observed in both tibial nerves. In patients with C-Th level, the SMAP amplitude was reduced on the left (2,5 [0,55; 5,65] mV) and right (2,7 [0,80; 6,30] mV) sides compared to those with C-C, in which CMAP was 4,6 [2,30; 6,20] mV on the left (=0.03) and 4,7 [2,80; 6,10] mV on the right sides (=0.03).
The main neurophysiological mechanisms of motor deficit in patients with post-traumatic cervical myelopathy are the combination of the primary neuronal damage at the level of spinal cord injury and the development of secondary axonal neuropathy more caudally at the first three years after spinal cord injury.
研究创伤性颈髓损伤患者运动功能障碍的神经生理机制。
对2008年至2018年期间进行回顾性临床和神经生理学研究。该研究纳入190例创伤性颈髓损伤患者（39例女性和159例男性，平均年龄27[21.0；36.0]岁，脊髓损伤后时间3[1.0；8.0]年）。92.5%的患者因脊髓损伤导致颈髓病变。入院时及康复期间采用国际脊髓损伤神经分类标准（ISNCSCI）进行评估。同时进行运动神经传导研究（NCS）。记录160条左侧和145条右侧正中神经、161条左侧和151条右侧胫神经、90条左侧和66条右侧尺神经远端节段的复合肌肉动作电位（CMAP）幅度和神经传导速度（NCV）。95例患者在受伤6（3.0；10.0）年后进行复查。两次检查间隔时间为2.9（1.0；4.0）年。正中神经和胫神经的对照组分别由10例年龄和性别匹配的创伤性截瘫患者和12名健康受试者组成。
在主要研究组中，正中神经的SMAP幅度为4.1[1.6；6.1]mV，NCV为56[51.0；61.0]m/s；在对照组中，SMAP为11[7.50；16.40]mV（P=0.00），NCV为59[58.0；60.0]m/s（P=0.00）；在主要研究组中，胫神经的SMAP幅度为4.3[0.65；7.95]mV，NCV为43[39.0；48.0]m/s，在对照组中SMAP为8.4[6.4；10.1]mV（P=0.00），NCV为50[47.0；51.0]m/s（P=0.00）。约20%的患者有严重的失神经改变。在临床完全性脊髓损伤患者中，所有神经的轴索性神经病（SMAP降低）比不完全性损伤患者更明显，且双侧胫神经均观察到NCV降低。与C-C节段患者相比，C-Th节段患者左侧（2.5[0.55；5.65]mV）和右侧（2.7[0.80；6.30]mV）的SMAP幅度降低，C-C节段患者左侧CMAP为4.6[2.30；6.20]mV（P=0.03），右侧为4.7[2.80；6.10]mV（P=0.03）。
创伤性颈髓损伤患者运动功能障碍的主要神经生理机制是脊髓损伤水平的原发性神经元损伤与脊髓损伤后最初三年更靠尾端的继发性轴索性神经病的共同作用。
