Inoue Takeshi, Soshi Shigeru, Kubota Makoto, Marumo Keishi
Department of Orthopaedic Surgery, The Jikei University School of Medicine, Tokyo, Japan.
Spine Surg Relat Res. 2020 Feb 26;4(3):216-222. doi: 10.22603/ssrr.2019-0076. eCollection 2020.
Cervical myelopathy frequently manifests as sensory disturbances, including numbness, and their distribution pattern aids in neurological level diagnosis. However, the objective assessment of sensory disturbances is challenging. In this study, we attempted to quantitatively evaluate sensory symptoms in patients with cervical myelopathy according to lesion level using PainVision.
Dermal sensations were evaluated in patients (n = 158) and healthy volunteers (n = 100) using PainVision PS-2100, which measured the current perception threshold (CPT). The results were analyzed for their correlation with magnetic resonance imaging (MRI) data, visual analog scale (VAS) scores, and patient functional status assessed by the Japanese Orthopaedic Association (JOA) and JOA Cervical Myelopathy Evaluation Questionnaire (JOACMEQ) scores.
Forearm and palm CPT values were significantly higher in patients with cervical myelopathy (both sites, < 0.001) and were negatively correlated with the JOA score (forearm, = -0.33; palm, = -0.35; < 0.001) and the JOACMEQ scores for upper extremity function (forearm, = -0.37; palm, = -0.39; < 0.001), lower extremity function (forearm, = -0.39; palm, = -0.40; < 0.001), and quality of life (forearm = -0.27, = 0.0025); however, no correlation was observed with the VAS score. Stratification of patients according to their lesion levels determined by MRI revealed that the C3/C4 subgroup had significantly higher forearm CPT values than the C4/C5 ( = 0.024) and C5/C6 ( = 0.0013) subgroups and higher palm CPT values than the C5/C6 subgroup ( = 0.009).
Quantitative measurements of sensory disturbances using the PainVision device correspond to the degree of patient functional disability and the lesion level. This indicates that both the distribution and intensity of sensory abnormalities are important for neurological level diagnosis in patients with cervical myelopathy.
脊髓型颈椎病常表现为感觉障碍，包括麻木，其分布模式有助于神经平面的诊断。然而，感觉障碍的客观评估具有挑战性。在本研究中，我们试图使用PainVision根据病变水平对脊髓型颈椎病患者的感觉症状进行定量评估。
使用PainVision PS - 2100对患者（n = 158）和健康志愿者（n = 100）的皮肤感觉进行评估，该设备测量电流感觉阈值（CPT）。分析结果与磁共振成像（MRI）数据、视觉模拟量表（VAS）评分以及由日本骨科协会（JOA）和JOA脊髓型颈椎病评估问卷（JOACMEQ）评分评估的患者功能状态之间的相关性。
脊髓型颈椎病患者的前臂和手掌CPT值显著更高（两个部位，均P < 0.001），并且与JOA评分呈负相关（前臂，r = - 0.33；手掌，r = - 0.35；P < 0.001）以及上肢功能的JOACMEQ评分（前臂，r = - 0.37；手掌，r = - 0.39；P < 0.001）、下肢功能（前臂，r = - 0.39；手掌，r = - 0.40；P < 0.001）和生活质量（前臂r = - 0.27，P = 0.0025）；然而，未观察到与VAS评分的相关性。根据MRI确定的病变水平对患者进行分层显示，C3/C4亚组的前臂CPT值显著高于C4/C5亚组（P = 0.024）和C5/C6亚组（P = 0.0013），手掌CPT值高于C5/C6亚组（P = 0.009）。
使用PainVision设备对感觉障碍进行定量测量与患者功能残疾程度和病变水平相对应。这表明感觉异常的分布和强度对于脊髓型颈椎病患者的神经平面诊断均很重要。
