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Cervical myelopathy: clinical and neurophysiological evaluation

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Abstract

The overall frequency of troublesome neck pain is estimated to be about 34%, and it was observed that the frequency of complaints lasting 1 month or longer was higher in women than in men. The prevalence increased with age, with regard to both pain duration and chronic pain. Approximately 14% of a randomly selected population meets the criterion for chronic neck pain: complaints lasting more than 6 months. Epidemiologic data substantiate the importance of morphologic, age-related changes of the cervical spine; however, the incidence and prevalence of cervical myelopathy is not known. It could be that the structural transformation of the intervertebral disc, the uncovertebral processes and the zygapophyseal joints is a process accompanied by disturbed function that ultimately not only induces pain, but can lead to narrowing of spinal canal, with symptoms and signs of cervical myelopathy. For a diagnosis of radicular and myelopathic syndromes, the functional and neurological examination is enhanced by neurophysiological assessment. Electromyography (EMG) performed with needle electrodes is the oldest method for diagnosing nerve root compression and anterior horn cell syndromes, and is claimed to have no false-positive results. For cervical myelopathy, as a routine examination sensory evoked potentials (SEPs) by stimulation of tibial nerve and motor evoked potentials (MEPs) from the upper and lower extremities are recommended.

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References

  1. Abbruzzese G, Dall’Agata D, Morena M, Simonetti S, Spadavecchia L, Severi P, Andrioli GC, Favale E (1988) Electrical stimulation of the motor tracts in cervical spondylosis. J Neurol Neurosurg Psychiatry 51:796–802

    CAS  PubMed  Google Scholar 

  2. Barker AT, Freeston IL, Alinous R, Merton PA, Morton HB (1985) Magnetic stimulation of the human brain. J Physiol 369:3

    Google Scholar 

  3. Barker AT, Jalinous R, Freeston IL (1985) Non-invasive magnetic stimulation of the human motor cortex. Lancet 1:1106–1107

    CAS  PubMed  Google Scholar 

  4. Bednarik J, Kadanka Z, Vohanka S, Novotny O, Surelova D, Filipovicova D, Prokes B (1998) The value of somatosensory and motor evoked potentials in pre-clinical spondylotic cervical cord compression. Eur Spine J 7:493–500

    Article  CAS  PubMed  Google Scholar 

  5. Bischoff C, Meyer BU, Machetanz J, Conrad B (1993) The value of magnetic stimulation in the diagnosis of radiculopathies. Muscle Nerve 16:154–161

    CAS  PubMed  Google Scholar 

  6. Britton TC, Meyer BU, Herdmann J, Benecke R (1990) Clinical use of the magnetic stimulator in the investigation of peripheral conduction time. Muscle Nerve 13:396–406

    CAS  PubMed  Google Scholar 

  7. Cadwell J (1989) Principles of magnetoelectric stimulation. In: Chokroverty S (ed) Magnetic stimulation in clinical neurophysiology. Butterworths, Boston, pp 13–32

  8. Chomiak J, Dvorak J, Antinnes J, Sandler A (1995) Motor evoked potentials: appropriate positioning of recording electrodes for diagnosis of spinal disorders. Eur Spine J 4:180–185

    CAS  PubMed  Google Scholar 

  9. Crock HV, Yoshizawa H (1977) The blood supply of the vertebral column and spinal cord in man. Springer, Vienna New York

  10. De Mattei M, Paschero B, Sciarretta A, Davini O, Cocito D (1993) Usefulness of motor evoked potentials in compressive myelopathy. Electromyogr Clin Neurophysiol 33:205–216

    PubMed  Google Scholar 

  11. Ebara S, Yonenobu K, Fujiwara K, Yamashita K, Ono K (1988) Myelopathy hand characterized by muscle wasting. A different type of myelopathic hand in patients with cervical spondylosis. Spine 13:785–791

    CAS  PubMed  Google Scholar 

  12. Esteban GR, Lagranja AR, Lopez MAC (1988) Delayed short-latency somatosensory evoked potentials in premature diagnosis of medullary disturbances in cervical spondylosis. Electromyogr Clin Neurophysiol 28:361–368

    PubMed  Google Scholar 

  13. Herdmann J, Linzbach M, Krzan M, Dvorak J, Bock WJ (1994) The European Myelopathy Score. In: Bauer BL, Brock M, Klinger M (eds) Advances in neurosurgery. Springer, Berlin Heidelberg, pp 266–268

  14. Kadanka Z, Mares M, Bednanik J, Smrcka V, Krbec M, Stejskal L, Chaloupka R, Surelova D, Novotny O, Urbanek I, Dusek L (2002) Approaches to spondylotic cervical myelopathy: conservative versus surgical results in a 3-year follow-up study. Spine 27:2205–2210; discussion 2210–2211

    Article  PubMed  Google Scholar 

  15. Kameyama O, Shibano K, Kawakita H, Ogawa R (1995) Transcranial magnetic stimulation of the motor cortex in cervical spondylosis and spinal canal stenosis. Spine 20:1004–1010

    CAS  PubMed  Google Scholar 

  16. Deleted in production

  17. Kellgren J, Lawrence J (1958) Osteo-arthrosis and disc degeneration in an urban population. Ann Rheum Dis 17:288–397

    Google Scholar 

  18. Kimura, J. (1974) F-wave velocity in the central segment of the median and ulnar nerves: a study in normal subjects and patients with Charcot-Marie-Tooth disease. Neurology 24:539–546

    CAS  PubMed  Google Scholar 

  19. Lawrence J (1969) Disc degeneration: its frequency and relationship to symptoms. Ann Rheum Dis 28:121–136

    CAS  PubMed  Google Scholar 

  20. Lhermitte F, Roullet E, Lyon-Caen O, Metrot J, Villey T, Bach MA, Tournier-Lasserve E, Chabassol E, Rascol A, Clanet M, et al (1986) [Double-blind treatment of 49 cases of chronic multiple sclerosis using hyperbaric oxygen]. Rev Neurol (Paris) 142:201–206

    Google Scholar 

  21. Luschka H (1858) Die Halbgelenke des menschlichen Körpers. Reimers, Berlin

  22. Matsumoto M, Toyama Y, Ishikawa M, Chiba K, Suzuki N, Fujimura Y (2000) Increased signal intensity of the spinal cord on magnetic resonance images in cervical compressive myelopathy. Does it predict the outcome of conservative treatment? Spine 25:677–682

    Article  CAS  PubMed  Google Scholar 

  23. Mills KR, Murray NMF (1986) Electrical stimulation over the human vertebral column: which neuronal elements are excited? Electroencephalogr Clin Neurophysiol 63:582–589

    CAS  PubMed  Google Scholar 

  24. Morio Y, Teshima R, Nagashima H, Nawata K, Yamasaki D, Nanjo Y (2001) Correlation between operative outcomes of cervical compression myelopathy and MRI of the spinal cord. Spine 26:1238–1245

    Article  CAS  PubMed  Google Scholar 

  25. Negrin P, Lelli S, Fardin P (1991) Contribution of electromyography to the diagnosis, treatment and prognosis of cervical disc disease: a study of 114 patients. Electromyogr Clin Neurophysiol 31:173–179

    CAS  PubMed  Google Scholar 

  26. Neuhuber WL, Zenker W (1989) Central distribution of cervical primary afferents in the rat, with emphasis on proprioceptive projections to vestibular, perihypoglossal, and upper thoracic spinal nuclei. J Comp Neurol 280:231–253

    CAS  PubMed  Google Scholar 

  27. Neuhuber WL, Zenker W, Bankoul S (1990) Central projections of cervical primary afferents in the rat. Some general anatomical principles and their functional significance. In: Neuhuber WL, Zenker W (eds) The primary afferent neuron. Plenum, New York, pp 173–188

  28. Norré ME (1979) Neck torsion nystagmus and neck motility. J Belg Med Phys 2:30–56

    Google Scholar 

  29. Norré ME (1985) Otoneurologischer Beitrag zum Problem des zervikalen Schwindels. In: Gutmann G (ed) Arteria vertebralis. Springer, Berlin Heidelberg New York, pp 123–131

  30. Ono K (1987) Myelopathy hand. New clinical signs of cervical cord damage. J Bone Joint Surg Br 69:215–219

    CAS  PubMed  Google Scholar 

  31. Penning L, Töndury G (1964) Entstehung, Bau und Funktion der meniskoiden Strukturen in den Halswirbelgelenken. Z Orthop Ihre Grenzgeb 98:1–14

    Google Scholar 

  32. Reiners K, Herdmann J, Freund HJ (1989) Altered mechanisms of muscular force generation in lower motor neuron disease. Muscle Nerve 12:647–659

    CAS  PubMed  Google Scholar 

  33. Roth G (1978) Intranervous regeneration of lower motor neuron. II. Study of 1153 motor axon reflexes. Second part: contralateral motor axon reflex crossed facial reinnervation. Electromyogr Clin Neurophysiol 18:311–350

    CAS  PubMed  Google Scholar 

  34. Sampath P, Bendebba M, Davis JD, Ducker TB (2000) Outcome of patients treated for cervical myelopathy. A prospective, multicenter study with independent clinical review. Spine 25:670–676

    Article  CAS  PubMed  Google Scholar 

  35. Shea P, Woods W, Werden D (1950) Electromyography in diagnosis of nerve root compression syndrome. Arch Neurol Psychiatry 64:93–104

    Google Scholar 

  36. Shimizu T, Shimada H, Shirakura K (1993) Scapulohumeral reflex (Shimizu). Its clinical significance and testing maneuver. Spine 18:2182–2190

    CAS  PubMed  Google Scholar 

  37. Tanaka M, Dvorak J (1999) The evaluation of motor evoked potentials (MEPs) by magnetic stimulation in cervial spondylotic myelopathy. Neuroorthopedics 125:75–89

    Google Scholar 

  38. Taylor J, Tworney L (1993) Acute injuries to cervical joints: an autopsy study of neck sprain. Spine 18:1115–1122

    CAS  PubMed  Google Scholar 

  39. Tepe HJ (1985) Die Häufigkeit osteochondrotischer Röntgenbefunde der Halswirbelsäule bei 400 symptomfreien Erwachsenen. Röfo 6:659–663

    Google Scholar 

  40. Töndury G, Theiler K (1990) Entwicklungsgeschichte und Fehlbildungen der Wirbelsäule, 2nd edn. Hippokrates-Verlag, Stuttgart

  41. Vohanka S, Dvorak J (1993) Motor and somatosensory evoked potentials in cervical spinal stenosis. Presented at the 40th Congress of the Czech and Slovak Neurophysiology, Brno

  42. Wälchli B, Dvorak J (1998) Axial symptoms including cervical migraine and cervical angina. In: Ono K, Dvorak J, Dunn E (eds) Cervical spondylosis and similar disorders. World Scientific, Singapore, New Jersey, London, pp 167–180

  43. Wilbourn A, Aminoff M (1988) AAEE Mini Monograph 32. The electrophysiological examination in patients with radiculopathies. Muscle Nerve 11:1011–1014

    Google Scholar 

  44. Yonenobu K (2000) Cervical radiculopathy and myelopathy: when and what can surgery contribute to treatment? Eur Spine J 9:1–7

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Neurology, Schulthess Clinic Spine Unit, Lengghalde 2, 8008, Zürich, Switzerland

    Jiri Dvorak

  2. Department of Neurophysiology, Intraoperative Monitoring, Schulthess Clinic Spine Unit, Zürich, Switzerland

    Martin Sutter

  3. Department of Neurosurgery, SPINE Unit, Heinrich-Heine-University, Düsseldorf, Germany

    Joerg Herdmann

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  1. Jiri Dvorak
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  2. Martin Sutter
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  3. Joerg Herdmann
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Correspondence to Jiri Dvorak.

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Dvorak, J., Sutter, M. & Herdmann, J. Cervical myelopathy: clinical and neurophysiological evaluation. Eur Spine J 12 (Suppl 2), S181–S187 (2003). https://doi.org/10.1007/s00586-003-0631-y

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  • DOI: https://doi.org/10.1007/s00586-003-0631-y

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