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Motor evoked potentials in the post-surgical follow-up of cervical spondylotic myelopathy

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Abstract

Eighteen patients (6 female, 12 male; average age 51 years, range 37–79) with clinical and radiological evidence (MRI) of cervical spondylotic myelopathy (CSM) were examined. The subjects were divided into two groups depending on whether radiology indicated single level (9 patients) or multilevel (9 patients) compression of the cervical cord. All of the patients underwent surgical decompression. Seriate exam with trans-cranial magnetic stimulation was performed in double session before surgery, and 3 and 12 months after surgery. The follow-up study of these patients revealed a statistically significant neurophysiological improvement only in those patients with single-level compression. In these cases, the cervical cord pathology revealed by MRI signal hyperintensity in T2 may at least partially consist of an edematous component and/or an initial demyelinization that has still a chance of recovery. In patients with multilevel damage, the compression may cause irreversible lesions.

Sommario

Sono stati esaminati 18 pazienti (6 femmine, 12 maschi), età media 51 anni (range 37–79), con evidenza clinica e radiologica (RMN) di mielopatia spondilosica cervicale (CSM). Essi sono stati suddivisi in due gruppi in base al dato radiologico di compressione midollare monofocale (9 pazienti) o multifocale (9 soggetti). Tutti i pazienti sono stati sottoposti ad intervento chirurgico decompressivo. È stato effettuato esame seriato con stimolazione magnetica a livello cranico nel preoperatorio in due distinte sedute (al fine di valutare l'effetto sui dati della variabilità legata alla metodica), a 3 e 12 mesi dopo l'intervento. I risultati ottenuti sono stati paragonati con i valori normali relativi a 20 soggetti normali.

Le alterazioni dei parametri neurofisiologici considerati (Tempo di conduzione centrale, ampiezza delle risposte evocate), più evidenti a carico delle vie destinate agli arti inferiori, non sono risultate di entità statisticamente differente nel gruppo dei soggetti con lesione mono e multifocale. Lo studio del follow up di questi pazienti ha rivelato un miglioramento statisticamente significativo sul piano neurofisiologico solo nei pazienti con compressione monofocale. Si può ipotizzare che in caso di compressione monofocale, la sofferenza midollare evidenziata alla NMR come iperintensità di segnale in T2, possa essere costituita, almeno in parte, da una componente edematosa e/o una iniziale demielinizzazione, ancora suscettibile di miglioramento. Nei pazienti con danno di tipo multifocale invece la compressione a più livelli più frequentemente dà luogo ad un danno di tipo ischemico che rende impossibile il recupero.

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Authors and Affiliations

  1. Dipartimento di Emergenza e Accettazione di Neurologia, Ospedale Molinette, C.so Bramante 88, Torino

    Mattei M. De, Cocito D., Cassano D., Campanella A. & Morgando E.

  2. Divisione di Ortopedia, Ospedale Molinette, Torino

    Paschero B.

  3. Divisione di Radiologia, Ospedale Molinette, Torino

    Rizzo L.

Authors
  1. Mattei M. De
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  2. Paschero B.
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  3. Cocito D.
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  4. Cassano D.
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  5. Campanella A.
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  6. Rizzo L.
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  7. Morgando E.
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De Mattei, M., Paschero, B., Cocito, D. et al. Motor evoked potentials in the post-surgical follow-up of cervical spondylotic myelopathy. Ital J Neuro Sci 16, 239–248 (1995). https://doi.org/10.1007/BF02282995

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  • DOI: https://doi.org/10.1007/BF02282995

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