Scheuren Paulina Simonne, Hupp Markus, Pfender Nikolai, Seif Maryam, Zipser Carl Moritz, Wanivenhaus Florian, Spirig José Miguel, Betz Michael, Freund Patrick, Schubert Martin, Farshad Mazda, Curt Armin, Hubli Michèle, Rosner Jan
Spinal Cord Injury Center, Balgrist University Hospital, University of Zurich, Zurich, Switzerland.
Department of Neurology, University Hospital Bern, Inselspital, University of Bern, Bern, Switzerland.
Eur J Neurol. 2025 Jan;32(1):e70001. doi: 10.1111/ene.70001.
Magnetic resonance imaging may suggest spinal cord compression and structural lesions in degenerative cervical myelopathy (DCM) but cannot reveal functional impairments in spinal pathways. We aimed to assess the value of contact heat evoked potentials (CHEPs) in addition to MRI and hypothesized that abnormal CHEPs may be evident in DCM independent of MR-lesions and are related to dynamic mechanical cord stress.
Individuals with DCM underwent neurologic examination including segmental sensory (pinprick, light touch) and motor testing. The presence or absence of hyperintense signal on T2-weighted MRI (T2-positive/negative) was assessed. Phase-contrast MRI was used to assess spinal cord motion as an indicator of dynamic mechanical stress. Dermatomal somatosensory evoked potentials and CHEPs were recorded after stimulation of dermatomes C6, C8, and T4 (CHEPs only) to assess spinal cord integrity.
Of 138 individuals included in this study (age 56 ± 13 years), 35% (N = 48) presented with T2-positive and 65% (N = 90) presented with T2-negative DCM. Abnormal CHEPs were present in T2-positive DCM (C6:41%; C8:32%; T4:24%) and T2-negative DCM (C6:35%; C8:54%; T4:26%). Multisegmental CHEP abnormalities at C6 and C8 were related to increased spinal cord motion (p = 0.030; ϵ = 0.072), and reduced upper extremity pinprick (p = 0.046; ϵ = 0.063) and motor scores (p = 0.005; ϵ = 0.108).
CHEPs revealed distinct patterns of spinal cord impairment independent of structural T2-positive lesions, which were associated with measures of cord motion. CHEPs thus provide valuable complementary diagnostic insights into spinal cord integrity beyond MRI. This is especially important in incipient myelopathy to inform early diagnosis and timely interventions before the development of definite cord lesions.
磁共振成像（MRI）可能提示退行性颈椎脊髓病（DCM）中的脊髓压迫和结构损伤，但无法揭示脊髓通路的功能损害。我们旨在评估接触热诱发电位（CHEPs）联合MRI的价值，并假设异常CHEPs在DCM中可能很明显，与MRI病变无关，且与动态机械性脊髓应力有关。
DCM患者接受了包括节段性感觉（针刺、轻触觉）和运动测试在内的神经学检查。评估T2加权MRI上高信号的有无（T2阳性/阴性）。使用相位对比MRI评估脊髓运动，作为动态机械应力的指标。刺激C6、C8和T4皮节（仅CHEPs）后记录皮节体感诱发电位和CHEPs，以评估脊髓完整性。
本研究纳入的138例患者（年龄56±13岁）中，35%（N = 48）为T2阳性DCM，65%（N = 90）为T2阴性DCM。T2阳性DCM（C6：41%；C8：32%；T4：24%）和T2阴性DCM（C6：35%；C8：54%；T4：26%）中均存在异常CHEPs。C6和C8处的多节段CHEP异常与脊髓运动增加相关（p = 0.030；ε = 0.072），与上肢针刺觉（p = 0.046；ε = 0.063）和运动评分降低相关（p = 0.005；ε = 0.108）。
CHEPs揭示了与结构性T2阳性病变无关的脊髓损伤的不同模式，这些模式与脊髓运动指标相关。因此，CHEPs为MRI之外的脊髓完整性提供了有价值的补充诊断见解。这在早期脊髓病中尤为重要，有助于在明确的脊髓病变发展之前进行早期诊断和及时干预。
