Kaneko K, Kawai S, Taguchi T, Fuchigami Y, Shiraishi G
Department of Orthopedic Surgery, University of Yamaguchi, School of Medicine, Japan.
Spine (Phila Pa 1976). 1997 Mar 15;22(6):636-40. doi: 10.1097/00007632-199703150-00012.
The authors investigated the clinical usefulness of recording motor evoked potentials after transcranial magnetic stimulation in coexisting peripheral nerve and cervical cord lesions.
To show that the measurement of central motor conduction time from the abductor policis brevis and the abductor digiti minimi can be used as a good screening method for double lesions involving peripheral nerves and the cervical cord.
Transcranial magnetic stimulation has been used in the diagnosis of compressive cervical myelopathy. This technique could be useful in the assessment of patients with an entrapment neuropathy and cervical myelopathy.
Motor evoked potentials after transcranial magnetic stimulation, compound muscle action potentials, and F waves after supramaximal peripheral nerve stimulation were recorded from the abductor policis brevis and the abductor digiti minimi. The central motor conduction time was calculated by subtracting the peripheral conduction time from the motor evoked potentials latency.
Ten patients with coexisting peripheral nerve and cervical cord lesions were evaluated. Two patients did not show satisfactory improvement after the decompression of the entrapment lesions, and six patients had hyperreflexia of lower limbs. In seven of these patients, the central motor conduction time was prolonged an average of 2.5 standard deviation of the normal value. The remaining two patients had spinal cord compression due to the ossification of the posterior longitudinal ligament. The spinal cord compression was demonstrated by magnetic resonance imaging, but the central motor conduction time was normal. Subjective symptoms improved in these two patients after decompressive surgery at the entrapment site alone.
Measurement of the central motor conduction time using motor evoked potentials is an ideal diagnostic approach for patients with coexisting entrapment neuropathy and cervical cord compression.
作者研究了经颅磁刺激后记录运动诱发电位在周围神经和颈髓并存病变中的临床应用价值。
表明测量拇短展肌和小指展肌的中枢运动传导时间可作为周围神经和颈髓双重病变的良好筛查方法。
经颅磁刺激已用于诊断压迫性颈椎病。该技术在评估患有卡压性神经病和颈椎病的患者中可能有用。
从拇短展肌和小指展肌记录经颅磁刺激后的运动诱发电位、复合肌肉动作电位以及超强周围神经刺激后的F波。通过从运动诱发电位潜伏期减去周围传导时间来计算中枢运动传导时间。
对10例周围神经和颈髓并存病变的患者进行了评估。2例患者在卡压性病变减压后未显示出满意的改善，6例患者下肢反射亢进。在其中7例患者中，中枢运动传导时间平均延长至正常值的2.5个标准差。其余2例患者因后纵韧带骨化导致脊髓受压。磁共振成像显示了脊髓受压，但中枢运动传导时间正常。仅在卡压部位进行减压手术后，这2例患者的主观症状有所改善。
使用运动诱发电位测量中枢运动传导时间是周围神经卡压性神经病和颈髓受压并存患者的理想诊断方法。
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