Spinal somatosensory evoked potentials in cervical cord lesions

Stöhr, Manfred; Buettner, U. W.; Riffel, B.; Koletzki, E.

doi:10.1016/0013-4694(82)90175-4

Cited by 69 publications

(7 citation statements)

References 11 publications

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“…Higher abnormality rates have indeed been detected in surface recordings in patients with cervical radiculopathy, especially if using stimulations of multiple nerves, segmental stimulations or larger numbers of averaged potentials 4,5,8,17,19 When analysing the epidural SEPs of this study it seemed that in mild cases only conduction disturbances (indicating myelin loss) occurred but in severe cases amplitude abnormalities (indicating axonal loss) were also seen.…”

Section: Discussionmentioning

confidence: 90%

“…Patients with cervical root and especially with cord lesions may show SEP abnormalities even in atraumatic skin recordings 4,5,8,17,19,2~ The number of abnormalities detected varies widely, however, from 0 (patients with only pains and paresthesias) to 100% (clear myelopathies) 8, 2o. Consequently, the role of skin SEPs in the routine diagnosis of cervical spondylosis has still not been firmly established.…”

Section: Introductionmentioning

confidence: 98%

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Comparison of somatosensory evoked responses from root and cord recorded by skin and epidural electrodes using stimulation of the median nerve in cervical radiculopathy and radiculomyelopathy

1986

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Somatosensory evoked potentials (SEPs) were recorded by stimulating the median nerve at the wrist from the skin and epidural space of the 7th cervical spine in patients suffering from cervical radiculopathy or radiculomyelopathy. The patients were divided into four subgroups according to the severity of the disease. Skin and epidural SEPs were calculated and compared with each other and with control values. Usually only one negative potential N13 was identified in the skin recording, but two potentials N11 and N13 occurred in the epidural recording. Lower amplitudes were obtained from the skin than from the epidural space. In the skin SEPs the mean of the central latency of N13 was significantly prolonged in the severe radiculomyelopathy groups, while the mean of the amplitude N13 showed only a tendency to decrease. In contrast, in the epidural SEPs a significant decrease in the mean of the N11 and N13 amplitudes together with a significant prolongation in the mean of the central latency of N13 could be found. In the epidural recording the amplitude changes in particular increased with the severity of the disease, but the highest number of abnormalities (61%) could be seen in the central latency of N13.

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Section: Discussionmentioning

confidence: 90%

Section: Introductionmentioning

confidence: 98%

Comparison of somatosensory evoked responses from root and cord recorded by skin and epidural electrodes using stimulation of the median nerve in cervical radiculopathy and radiculomyelopathy

1986

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“…32 The most common SSEP abnormality described in patients with syringomyelia is the attenuation or absence of N 13 -potential with a normal N 20 -potential, a parameter susceptible to spinal cord lesions involving the gray matter but sparing the dorsal columns. 16,28,33,39,42 With this finding even subclinical dysfunctions of the thoracic column pathways can be detected. 16,28,44 Although it has been proven that SSEPs do not reflect spinothalamic pathways, 29,33,36 several investigators have described a correlation between N 13 -negativity after pain stimuli to clinical loss of pain and temperature sensation.…”

Section: Discussionmentioning

confidence: 91%

A new concept in the electrophysiological evaluation of syringomyelia

Röser¹,

Ebner²,

Liebsch³

et al. 2008

SPI

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Object The current neurophysiological assessment of syringomyelia is inadequate. Early-stage syringomyelia is anatomically predisposed to affect decussating spinothalamic fibers that convey pain and sensation primarily. Silent periods have been proven to be a sensitive tool for detecting alterations in this pathway. Methods Thirty-seven patients with syringomyelia were included in this prospective study. Routine electrophysiological measurements were applied including somatosensory evoked potential (SSEP) and motor evoked potential (MEP) recordings for all extremities. The silent periods were recorded from the pollicis brevis muscle, and electrical stimuli were applied to the ipsilateral digiti II. To establish baseline values, the authors had 28 healthy controls undergo monitoring. Sensitivity and specificity values were statistically evaluated according to the main clinical symptoms (paresis, dissociative syndrome, and pain). Results All control individuals had normal silent periods in voluntarily activated muscle. In syringomyelia patients, the affected limb showed pathological silent periods with all symptoms (sensitivity 30–50%). Pain was the most specific symptom (90%), despite SSEP and MEP values that were within the normal range. Conclusions Silent period testing is a sensitive neurophysiological technique and an invaluable tool for preoperative assessment of syringomyelia. Silent periods are associated with early dysfunction of thin myelinated spinothalamic tract fibers, even when routine electrophysiological measurements still reveal normal values. Conduction abnormalities that selectively abolish the silent periods can distinguish between hydromyelia (a physiologically dilated central canal) and space-occupying syringomyelia.

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“…Es liegen viele Untersuchungen vor, die pathologische SEP-Befunde bei spinalen bzw. Hirnstammläsionen zeigen (2,5,8,12,19,(23)(24)(25)(26)(27)29,30,33,35,36,(40)(41)(42)(43)47,(49)(50)(51)(52)(53)(55)(56)(57)(58)(59)61,62). Der Wert einer solchen subtilen Analyse für die klinischneurologische Diagnostik ist jedoch, abgesehen von Einzeldarstellungen nicht klar.…”

Section: Zusammenfassungunclassified

“…Ausgefallene subkortikale Potentiale N13 und P14 waren immer mit einer Tétraplégie verbunden. Diese Befunde wurde bereits mehrfach in der Literatur beschrieben (27,50,58,61,62). In zwei größeren Patientenserien wurde kein Zusammenhang zwischen dem Ausmaß der SEP-Veränderungen und dem radiologischen Nachweis einer zervikalen Myelopathie festgestellt (58,62).…”

Section: Diskussionunclassified