Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan.
Department of Orthopaedic and Traumatology, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia.
Spine (Phila Pa 1976). 2024 Dec 1;49(23):E387-E393. doi: 10.1097/BRS.0000000000004992. Epub 2024 Mar 20.
A retrospective case-control study.
To characterize the motor evoked potential (MEP) when the epiconus or conus medullaris is compressed by a fracture of the T12 or L1 vertebra.
Although the characteristics of compressive cervical and thoracic myelopathy with transcranial magnetic stimulation MEP have been reported, the MEP parameters in compressive disorders of the epiconus and conus medullaris have not yet been characterized.
Twenty patients with T12 or L1 vertebral fractures who had lower extremity symptoms due to compression of the epiconus or conus medullaris were included. These patients were compared with 28 healthy controls and 32 patients with cervical spondylotic radiculopathy (CSR) without spinal cord compression. MEPs of abductor hallucis muscles were recorded using transcranial magnetic stimulation and electrical stimulation of the tibial nerve. MEP latency, central motor conduction time (CMCT), and peripheral conduction time (PCT) were evaluated.
MEP latency, CMCT, and PCT were significantly longer in patients with fractures than in healthy controls and patients with CSR. MEP latency was most accurate for differentiating patients with fracture from healthy controls (cutoff value, 40.0 ms, sensitivity, 95.0%; specificity, 100%), and CMCT was most accurate for comparing patients with fracture and CSR (cutoff value, 15.5 ms, sensitivity, 80.0%; specificity, 93.8%). In the distinction between patients with fracture and CSR, 16 of the 20 patients with fracture exceeded the cutoff values for any of the parameters, and 12 of them exceeded the cutoff values for all parameters. There was no significant correlation between the linear distance from the most inferior end of the spinal cord to the site of compression and any of the MEP parameters.
Both CMCT and PCT are often prolonged in compressive lesions of the epiconus and conus medullaris, and MEP latency and CMCT are useful in the diagnosis.
回顾性病例对照研究。
描述 T12 或 L1 椎体骨折时脊髓圆锥或终丝受压时的运动诱发电位（MEP）特征。
尽管已经报道了经颅磁刺激 MEP 对压迫性颈胸脊髓病变的特征，但压迫性终丝和脊髓圆锥病变的 MEP 参数尚未得到描述。
纳入 20 例因压迫性终丝或脊髓圆锥而出现下肢症状的 T12 或 L1 椎体骨折患者，并与 28 例健康对照者和 32 例无脊髓压迫的颈椎病神经根病（CSR）患者进行比较。使用经颅磁刺激和胫神经电刺激记录拇展肌的 MEP。评估 MEP 潜伏期、中枢运动传导时间（CMCT）和周围传导时间（PCT）。
骨折患者的 MEP 潜伏期、CMCT 和 PCT 均明显长于健康对照者和 CSR 患者。MEP 潜伏期区分骨折患者与健康对照者最准确（截断值 40.0ms，敏感性 95.0%，特异性 100%），CMCT 区分骨折患者与 CSR 最准确（截断值 15.5ms，敏感性 80.0%，特异性 93.8%）。在骨折患者和 CSR 患者的区分中，20 例骨折患者中有 16 例超过任何参数的截断值，其中 12 例超过所有参数的截断值。脊髓最下端至压迫部位的直线距离与任何 MEP 参数均无显著相关性。
脊髓圆锥和终丝受压病变时 CMCT 和 PCT 常延长，MEP 潜伏期和 CMCT 有助于诊断。
