Electrophysiological evidence of functional improvement in the corticospinal tract after laminoplasty in patients with cervical compressive myelopathy

Nakanishi, Kazuyoshi; Tanaka, Nobuhiro; Kamei, Naosuke; Ohta, Ryo; Fujioka, Yuki; Hiramatsu, Takeshi; Ujigo, Satoshi; Ochi, Mitsuo

doi:10.3171/2014.4.spine13545

Cited by 20 publications

(15 citation statements)

References 37 publications

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“…The type III, IV, and V MEPs baseline can often gradually reflect the severity of clinical symptoms. Some previous study also showed a correlation between the mJOA score and the electrophysiological parameters in CCM [7,18,19,46]. Moreover, according to this study and previous report [47], the cervical cord morphology and electrophysiological parameters are also relevant in CCM.…”

Section: Discussionsupporting

confidence: 85%

“…It is important to assess cervical cord function in patients with CCM during surgical treatment. Over the past decades, the majority of studies are concerning the application of intraoperative transcranial motor evoked potential (MEP) to detect impending spinal cord damage, early warning the operating team to take action to avoid injury in cervical spine surgery [2][3][4][5][6][7].…”

Section: Introductionmentioning

confidence: 99%

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The prediction of intraoperative cervical cord function changes by different motor evoked potentials phenotypes in cervical myelopathy patients

et al. 2020

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Background: Surgery is usually the treatment of choice for patients with cervical compressive myelopathy (CCM). Motor evoked potential (MEP) has proved to be helpful tool in evaluating intraoperative cervical spinal cord function change of those patients. This study aims to describe and evaluate different MEP baseline phenotypes for predicting MEP changes during CCM surgery. Methods: A total of 105 consecutive CCM patients underwent posterior cervical spine decompression were prospectively collected between December 2012 and November 2016. All intraoperative MEP baselines recorded before spinal cord decompression were classified into 5 types (I to V) that were carefully designed according to the different MEP parameters. The postoperative neurologic status of each patient was assessed immediately after surgery. Results: The mean intraoperative MEP changes range were 10.2% ± 5.8, 14.7% ± 9.2, 54.8% ± 31.9, 74.1% ± 24.3, and 110% ± 40 in Type I, II, III, IV, and V, respectively. There was a significant correlation of the intraoperative MEP change rate with different MEP baseline phenotypes (r = 0.84, P < 0.01). Postoperative transient new spinal deficits were found 0/31 case in Type I, 0/21 in Type II, 1/14 in Type III, 2/24 in Type IV, and 4/15 in Type V. No permanent neurological injury was found in our cases series. Conclusions: The MEP baselines categories for predicting intraoperative cervical cord function change is proposed through this work. The more serious the MEP baseline abnormality, the higher the probability of intraoperative MEP changes, which is beneficial to early warning for the cervical cord injury.

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Section: Discussionsupporting

confidence: 85%

Section: Introductionmentioning

confidence: 99%

The prediction of intraoperative cervical cord function changes by different motor evoked potentials phenotypes in cervical myelopathy patients

et al. 2020

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“…Correlations between CMCT and the JOA score have been reported. 31,37 However, our results showed no correlation between the JOA score and CMCT in the CCM-DM group. In the CCM-DM group, the JOA score correlated with the MEP-AH and PCT-AH before and after surgery, while the JOA score before surgery correlated with the CMCT and MEP values in the CCM group.…”

Section: Discussioncontrasting

confidence: 53%

“…37 CMCT values improved after cervical laminoplasty with significant correlations to the JOA score before and after surgery. 31 Moreover, sufficient clinical results have been reported even in myelopathy patients older than 80 years, provided the patients are selected correctly through electrophysiological evaluation via MEP and CMCT study. 38 However, those studies excluded diabetic patients or did not clearly mention the patients with DM.…”

Section: Discussionmentioning

confidence: 99%

Electrophysiological assessments of the motor pathway in diabetic patients with compressive cervical myelopathy

Nakanishi¹,

Tanaka²,

Kamei³

et al. 2015

SPI

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OBJECT The occurrence of compressive cervical myelopathy (CCM) increases in adults over 50 years of age. In addition, diabetes mellitus (DM) is a frequent comorbidity for people of this age and may impact the severity of CCM. The authors assessed motor pathway function in diabetic patients with CCM to investigate the correlation between electrophysiological parameters and clinical symptoms. METHODS Motor evoked potentials (MEPs) were measured from the abductor digiti minimi muscle (ADM) and the abductor hallucis muscle (AH) following transcranial magnetic stimulation, as were M- and F-waves following electrical stimulation of the ulnar and tibial nerves, in 22 patients with CCM and diabetes mellitus (DM) who had not experienced symptomatic diabetic neuropathy (CCM-DM group), in 92 patients with CCM alone (CCM group), and in 24 healthy adults (control group). The peripheral conduction time (PCT; measured from the ADM and AH) was calculated as follows: (M-wave latency + F-wave latency −1)/2. The central motor conduction time (CMCT; measured from the ADM and AH) was calculated by subtracting the PCT from the onset latency of the MEPs. The Japanese Orthopaedic Association (JOA) score for cervical myelopathy was obtained before and 1 year after surgery as a clinical outcome measure. RESULTS MEP, PCT, and CMCT parameters in the CCM-DM and CCM groups were significantly longer than those in the control group (p = 0.000−0.007). The PCTs in the CCM-DM group were significantly longer than those in the CCM group (p = 0.001−0.003). No significant differences were detected in the MEP and CMCT parameters between the CCM-DM and CCM groups (p = 0.080–1.000). The JOA score before surgery in the CCM-DM group was 10.7 ± 2.0 points and was significantly lower than that in the CCM group (12.2 ± 2.5 points, p = 0.015). In the CCM-DM group, JOA scores before surgery correlated with MEP-AH (r = −0.610, p = 0.012) and PCT-AH (r = −0.676, p = 0.004) values, but not with CMCT values, while the JOA scores were related to both MEP and CMCT parameters in the CCM group. The JOA scores improved to 13.8 ± 2.2 points after surgery (p = 0.001) and correlated with MEP-AH (r = −0.667, p = 0.005) and PCT-AH (r = −0.611, p = 0.012) in the CCM-DM group. CONCLUSIONS The results suggest that MEP, PCT, and CMCT parameters each reveal abnormalities in the upper and lower motor neurons even in patients with DM. The results also show a prolonged PCT in CCM-DM patients, despite having no history of diabetic neuropathy. Corticospinal tract impairments are similar between CCM and CCM-DM patients, while the JOA score of the CCM-DM patients is lower than that in the CCM patients. The JOA score in CCM-DM patients may be influenced by additional impairments in peripheral nerves or other diabetic complications. These electrophysiological studies may be useful for screening motor pathway function for CCM in patients with DM.

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“…Similar to our result in CCM, previous study also proved a correlation between the JOA score and the electrophysiological parameters. 11 Therefore, we can assert that there are significant correlations among cervical cord morphology, electrophysiological parameters, and JOA score.…”

Section: Discussionmentioning

confidence: 98%

Exploration of the Intraoperative Motor Evoked Potential

Wang

Tian²

2016

SPINE

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Electrophysiological evidence of functional improvement in the corticospinal tract after laminoplasty in patients with cervical compressive myelopathy

Cited by 20 publications

References 37 publications

The prediction of intraoperative cervical cord function changes by different motor evoked potentials phenotypes in cervical myelopathy patients

The prediction of intraoperative cervical cord function changes by different motor evoked potentials phenotypes in cervical myelopathy patients

Electrophysiological assessments of the motor pathway in diabetic patients with compressive cervical myelopathy

Exploration of the Intraoperative Motor Evoked Potential

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