A new method for characterizing hand dysfunction in cervical spondylotic myelopathy: a preliminary study

Akutagawa, Tomoaki; Tani, Tohru; Kida, Kenji; Tadokoro, Nobuaki; Enoki, Hayato; Nagano, Yasunori; Ikeuchi, Masahiko

doi:10.1038/sc.2015.123

Cited by 9 publications

(6 citation statements)

References 19 publications

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“…Degeneration does not necessarily occur in the anterograde direction only, and retrograde degeneration also occurs; however, antegrade Wallerian degeneration could explain the location of the pathologic change based on the positional relation with the lesion [ 15 ]. FC is an ascending tract that transmits proprioceptive and cutaneous feedback signals to the upper extremities; therefore, the group difference above the level of the lesion, which was confirmed in our study, was consistent with previous studies [ 47 , 48 ]. However, we were unable to explain why the DTI values of some tracts were better in patients than in the controls because this phenomenon has not been previously reported.…”

Section: Discussionsupporting

confidence: 93%

Utility of Diffusion and Magnetization Transfer MRI in Cervical Spondylotic Myelopathy: A Pilot Study

Yang

Kim

et al. 2022

Diagnostics

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Diffusion tensor imaging (DTI) and magnetization transfer (MT) magnetic resonance imaging (MRI) can help detect spinal cord pathology, and tract-specific analysis of their parameters, such as fractional anisotropy (FA), mean diffusivity, axial diffusivity (AD), radial diffusivity (RD) and MT ratio (MTR), can give microstructural information. We performed the tract-based acquisition of MR parameters of three major motor tracts: the lateral corticospinal (CS), rubrospinal (RuS) tract, and lateral reticulospinal (RS) tract as well as two major sensory tracts, i.e., the fasciculus cuneatus (FC) and spinal lemniscus, to detect pathologic change and find correlations with clinical items. MR parameters were extracted for each tract at three levels: the most compressed lesion level and above and below the lesion. We compared the MR parameters of eight cervical spondylotic myelopathy patients and 12 normal controls and analyzed the correlation between clinical evaluation items and MR parameters in patients. RuS and lateral RS showed worse DTI parameters at the lesion level in patients compared to the controls. Worse DTI parameters in those tracts were correlated with weaker power grasp at the lesion level. FC and lateral CS showed a correlation between higher RD and lower FA and MTR with a weaker lateral pinch below the lesion level.

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Section: Discussionsupporting

confidence: 93%

Utility of Diffusion and Magnetization Transfer MRI in Cervical Spondylotic Myelopathy: A Pilot Study

Yang

Kim

et al. 2022

Diagnostics

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“…Doita et al reported a direct relationship between clinical myelopathy and proprioceptive ability in a hand function test [22]. In a study comparing CSM patients and normal controls, Akutagawa et al, found that myelopathy patients required a higher pinch pressure to grasp and hold small objects [23]. These studies suggest that impairment of the hand may be related to injuries to both the motor and sensory spinal tracts of the cervical spinal cord.…”

Section: Resultsmentioning

confidence: 99%

Assessing hand dysfunction in cervical spondylotic myelopathy

et al. 2019

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Cervical Spondylotic Myelopathy (CSM) is a common spinal condition that presents as hyperreflexia, loss of dexterity, and strength. Despite its prevalence, little is known about the specific neuromechanical deficits that constitute overall disability in CSM. Compression on MRI doesn’t exclusively relate to disability. Moreover, clinical assessment often relies on the subjective exams and self-reported questionnaires. Therefore, the purpose of this study was to assess hyperreflexia, proprioception, and loss of strength, and its association with common MRI scales.MethodsTwenty patients with CSM and 17 controls were recruited. Clinical scores of modified Japanese Orthopedic Association (mJOA) and Nurick were collected. MRI based compression grades such as cord distortion were assessed. Hand dysfunction was tested using a custom motorized apparatus. Subject’s forearm was placed in a cast and positioned such that their metacarpophalangeal (MCP) joint was vertically aligned with the motor shaft. Surface electromyographic sensors were placed on flexor digitorum superficialis (FDS) and extensor digitorum communis muscles. Hyperreflexia was measured as the FDS muscle activation during reflex when the MCP joint was moved from flexion to extension at 300°/sec. Proprioception was quantified as the angle of detection in absence of visual or auditory cues (subjects were blindfolded and given noise-cancelling headphones). Strength was measured as the maximum isometric force at the MCP joint. 2-sample t-test (p<0.05) were performed to assess significant differences in reflexes, proprioception and strength among patients and controls (SPSS software version 24).ResultsPatients reported higher Nurick (1.90±1.0 vs 0±0, p<0.001) and lower mJOA scores (14.3±1.9 vs 18.0±0, p<0.001) as compared to controls. Similarly, patients with CSM had increased reflexes (peak FDS EMG) (0.073±0.096 vs. 0.014±0.010, p = 0.019). Patient proprioception was significantly worse; mean angle of detection was greater than twice as high in patients (9.6± 9.43°) compared to controls (4.0± 2.3°), p = 0.022. MRI based compression ratio (CR) was a significant predictor of hyperreflexia, CR<0.44 resulted in steep increase in reflex activity. Fifteen of the 20 patients who completed follow up testing at 6 months after surgery show substantial clinical improvement in reflexes and proprioceptive angle, while repeated testing in controls were unchanged.ConclusionIn conclusion, hyperreflexia and decline in proprioception are the main drivers of hand disability in patients with CSM. Of multiple scales, only a select few MRI scales (such as compression ratio) were predictive of increased reflexes. The study describes a pre-clinical testing apparatus to quantitatively and objectively assess primary presenting symptoms in CSM. This pilot apparatus has the potential to evaluate treatment efficacy through repeated testing. Objective testing of hand dysfunction can help inform the design of clinically feasible devices, guide MRI biomarker analysis, and improve our understandi...

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“…Degenerative cervical myelopathy (DCM) is the most common cause of non-traumatic neurological dysfunction of the spinal cord in adults [1]. The degenerative changes that occur in this condition involve the intervertebral discs, vertebral bodies, facet joints, hypertrophy of the ligamentum flavum, and ossification of the posterior longitudinal ligament (OPLL) [2].…”

Section: Introductionmentioning

confidence: 99%

Composite Grip Strength as a Marker of Outcome in Patients Surgically Treated for Degenerative Cervical Myelopathy

et al. 2021

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This study aimed to examine the efficacy of composite grip strength as a marker of surgical outcome in patients with moderate to severe degenerative cervical myelopathy. Overview of Literature: Degenerative cervical myelopathy causes loss of dexterity, muscle strength, and sensations in the hand. The impact of surgical management on improvement in composite grip strength has received scant attention. Methods: This retrospective study was performed on degenerative cervical myelopathy patients with a complete composite grip strength assessment between January 2013 to January 2019. The Biometrics E-link hand kit was used for the assessment. The following parameters were measured: maximum grip strength, sustained grip strength, three-jaw pinch, maximum key pinch, and sustained key pinch. The pre-and postoperative functional status was assessed using the Nurick grade and the modified Japanese Orthopaedic Association (mJOA) score. Results: A total of 40 patients were included in the study. The mean patient age was 51.9 years. The mean preoperative Nurick grade was 3.5 and the mJOA score was 10.9. The anterior approach was used in 25 patients, and the posterior approach was used in 15 patients. Four patients developed complications. Degenerative cervical myelopathy resulted in decreased handgrip and pinch strength as compared to normative Indian data. There was a significant improvement in the postoperative composite grip strength for all five parameters. There was no differential improvement between the anterior and posterior surgical groups. The improvement in the composite grip strength correlated with the improvement in functional scores. Conclusions: Composite grip strength analysis is an objective method for assessing the impact of degenerative cervical myelopathy on grip strength and monitoring the postoperative improvement. Decompressive surgery resulted in global improvement in all the parameters of composite grip strength.

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A new method for characterizing hand dysfunction in cervical spondylotic myelopathy: a preliminary study

Cited by 9 publications

References 19 publications

Utility of Diffusion and Magnetization Transfer MRI in Cervical Spondylotic Myelopathy: A Pilot Study

Utility of Diffusion and Magnetization Transfer MRI in Cervical Spondylotic Myelopathy: A Pilot Study

Assessing hand dysfunction in cervical spondylotic myelopathy

Composite Grip Strength as a Marker of Outcome in Patients Surgically Treated for Degenerative Cervical Myelopathy

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