Progression Prediction of Mild Cervical Spondylotic Myelopathy by Somatosensory-evoked Potentials.
Adult
Aged
Aged, 80 and over
Cervical Vertebrae
/ physiopathology
Disease Progression
Evoked Potentials, Somatosensory
/ physiology
Female
Follow-Up Studies
Humans
Magnetic Resonance Imaging
/ trends
Male
Median Nerve
/ physiology
Middle Aged
Predictive Value of Tests
Prognosis
Retrospective Studies
Spinal Cord Diseases
/ physiopathology
Spondylosis
/ physiopathology
Tibial Nerve
/ physiology
Journal
Spine
ISSN: 1528-1159
Titre abrégé: Spine (Phila Pa 1976)
Pays: United States
ID NLM: 7610646
Informations de publication
Date de publication:
15 May 2020
15 May 2020
Historique:
pubmed:
27
11
2019
medline:
23
9
2020
entrez:
27
11
2019
Statut:
ppublish
Résumé
Retrospective study to correlate classification of somatosensory-evoked potentials (SEPs) with symptomatic progress of patients with mild cervical spondylotic myelopathy (CSM). The aim of this study was to evaluate the usefulness of SEPs for predicting symptomatic progress of mild CSM. SEPs have been used for clinical diagnosis and intraoperative neuromonitoring in patients with CSM. However, the prognostic value of SEPs in predicting the progression of CSM remains unclear. A total of 200 patients with a clinical diagnosis of mild CSM were enrolled between September 2014 and February 2018. All patients received clinical assessment with the modified Japanese Orthopedic Association scale (mJOA), magnetic resonance imaging, and SEP tests in the first clinical visit and at 1-year follow-up. A classification of upper and lower limbs SEP was developed. At 1-year follow-up, patients with symptom decline >2 points in mJOA were considered progressive myelopathy cases. The relationship of progressive myelopathy and classifications of SEP was investigated. Fifty-four of 200 cases presented with progressive myelopathy. The incidence of progressive myelopathy was 2.6%, 27.7%, 23.8%, 86.7%, and 100% in Class I, II, III, IV, and V of upper SEPs, respectively, and 18.8%, 39.4%, 42.3%, and 62.5% in Class I, II, III, and IV of lower SEPs, respectively. For the combination classification of upper and lower SEPs, the incidence of progressive myelopathy was 0%, 13.7%, 24.3%, 91.1%, and 100% in Class I, II, III, IV, and V, respectively. There was a significant correlation of the incidence of progressive myelopathy with SEP classification for the upper SEPs (r = 0.94, P < 0.01) and the combination SEPs (r = 0.95, P < 0.01). The incidence of progressive degenerative myelopathy increased with the upper and combination SEP classifications. Thus, classification of SEPs could predict the clinical decline in mJOA in CSM, reflecting the probability of worsening of myelopathy. 4.
Sections du résumé
STUDY DESIGN
METHODS
Retrospective study to correlate classification of somatosensory-evoked potentials (SEPs) with symptomatic progress of patients with mild cervical spondylotic myelopathy (CSM).
OBJECTIVE
OBJECTIVE
The aim of this study was to evaluate the usefulness of SEPs for predicting symptomatic progress of mild CSM.
SUMMARY OF BACKGROUND DATA
BACKGROUND
SEPs have been used for clinical diagnosis and intraoperative neuromonitoring in patients with CSM. However, the prognostic value of SEPs in predicting the progression of CSM remains unclear.
METHODS
METHODS
A total of 200 patients with a clinical diagnosis of mild CSM were enrolled between September 2014 and February 2018. All patients received clinical assessment with the modified Japanese Orthopedic Association scale (mJOA), magnetic resonance imaging, and SEP tests in the first clinical visit and at 1-year follow-up. A classification of upper and lower limbs SEP was developed. At 1-year follow-up, patients with symptom decline >2 points in mJOA were considered progressive myelopathy cases. The relationship of progressive myelopathy and classifications of SEP was investigated.
RESULTS
RESULTS
Fifty-four of 200 cases presented with progressive myelopathy. The incidence of progressive myelopathy was 2.6%, 27.7%, 23.8%, 86.7%, and 100% in Class I, II, III, IV, and V of upper SEPs, respectively, and 18.8%, 39.4%, 42.3%, and 62.5% in Class I, II, III, and IV of lower SEPs, respectively. For the combination classification of upper and lower SEPs, the incidence of progressive myelopathy was 0%, 13.7%, 24.3%, 91.1%, and 100% in Class I, II, III, IV, and V, respectively. There was a significant correlation of the incidence of progressive myelopathy with SEP classification for the upper SEPs (r = 0.94, P < 0.01) and the combination SEPs (r = 0.95, P < 0.01).
CONCLUSION
CONCLUSIONS
The incidence of progressive degenerative myelopathy increased with the upper and combination SEP classifications. Thus, classification of SEPs could predict the clinical decline in mJOA in CSM, reflecting the probability of worsening of myelopathy.
LEVEL OF EVIDENCE
METHODS
4.
Identifiants
pubmed: 31770314
doi: 10.1097/BRS.0000000000003348
pii: 00007632-202005150-00006
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
E560-E567Références
Badhiwala JH, Witiw CD, Nassiri F, et al. Patient phenotypes associated with outcome following surgery for mild degenerative cervical myelopathy: a principal component regression analysis. Spine J 2018; 18:2220–2231.
Sonntag VK. The asymptomatic degenerative cervical disc: a dilemma. World Neurosurg 2012; 78:241–242.
Weis EB Jr. Abnormal magnetic-resonance scans of the cervical spine in asymptomatic subjects. J Bone Joint Surg Am 1991; 73:1113.
Boden SD, McCowin PR, Davis DO, et al. Abnormal magnetic-resonance scans of the cervical spine in asymptomatic subjects. A prospective investigation. J Bone Joint Surg Am 1990; 72:1178–1184.
Wilson JR, Barry S, Fischer DJ, et al. Frequency, timing, and predictors of neurological dysfunction in the nonmyelopathic patient with cervical spinal cord compression, canal stenosis, and/or ossification of the posterior longitudinal ligament. Spine (Phila Pa 1976) 2013; 38:S37–54.
Bednarik J, Kadanka Z, Dusek L, et al. Presymptomatic spondylotic cervical cord compression. Spine (Phila Pa 1976) 2004; 29:2260–2269.
Bednarik J, Kadanka Z, Dusek L, et al. Presymptomatic spondylotic cervical myelopathy: an updated predictive model. Eur Spine J 2008; 17:421–431.
Fehlings MG, Wilson JR, Kopjar B, et al. Efficacy and safety of surgical decompression in patients with cervical spondylotic myelopathy: results of the AOSpine North America prospective multi-center study. J Bone Joint Surg Am 2013; 95:1651–1658.
Fehlings MG, Ibrahim A, Tetreault L, et al. A global perspective on the outcomes of surgical decompression in patients with cervical spondylotic myelopathy: results from the prospective multicenter AOSpine international study on 479 patients. Spine (Phila Pa 1976) 2015; 40:1322–1328.
Kadanka Z, Mares M, Bednarik J, et al. Predictive factors for mild forms of spondylotic cervical myelopathy treated conservatively or surgically. Eur J Neurol 2005; 12:16–24.
Sumi M, Miyamoto H, Suzuki T, et al. Prospective cohort study of mild cervical spondylotic myelopathy without surgical treatment. J Neurosurg Spine 2012; 16:8–14.
Fehlings MG, Kwon BK, Tetreault LA. Guidelines for the management of degenerative cervical myelopathy and spinal cord injury: an introduction to a focus issue. Global Spine J 2017; 7:6S–7S.
Fehlings MG, Tetreault LA, Riew KD, et al. A clinical practice guideline for the management of patients with degenerative cervical myelopathy: recommendations for patients with mild, moderate, and severe disease and nonmyelopathic patients with evidence of cord compression. Global Spine J 2017; 7:70S–83S.
Ito T, Oyanagi K, Takahashi H, et al. Cervical spondylotic myelopathy—clinicopathologic study on the progression pattern and thin myelinated fibers of the lesions of seven patients examined during complete autopsy. Spine (Phila Pa 1976) 1996; 21:827–833.
Badhiwala JH, Witiw CD, Nassiri F, et al. Efficacy and safety of surgery for mild degenerative cervical myelopathy: results of the AOSpine North America and International Prospective Multicenter Studies. Neurosurgery 2019; 84:890–897.
Telemacque D, Zhu F, Chen K, et al. Method of Decompression by durotomy and duroplasty for cervical spinal cord injury in patients without fracture or dislocation. J Neurorestoratol 2018; 6:158–164.
Kadanka Z, Mares M, Bednarik J, et al. Predictive factors for spondylotic cervical myelopathy treated conservatively or surgically. Eur J Neurol 2005; 12:55–63.
Kadanka Z, Bednarik J, Novotny O, et al. Cervical spondylotic myelopathy: conservative versus surgical treatment after 10 years. Eur Spine J 2011; 20:1533–1538.
Tetreault L, Ibrahim A, Cote P, et al. A systematic review of clinical and surgical predictors of complications following surgery for degenerative cervical myelopathy. J Neurosurg Spine 2016; 24:77–99.
Bednarik J, Kadanka Z, Vohanka S, et al. The value of somatosensory and motor evoked evoked potentials in pre-clinical spondylotic cervical cord compression. Eur Spine J 1998; 7:493–500.
Restuccia D, Valeriani M, Di Lazzaro V, et al. Somatosensory evoked potentials after multisegmental upper limb stimulation in diagnosis of cervical spondylotic myelopathy. J Neurol Neurosurg Psychiatry 1994; 57:301–308.
Nakai S, Sonoo M, Shimizu T. Somatosensory evoked potentials (SEPs) for the evaluation of cervical spondylotic myelopathy: utility of the onset-latency parameters. Clin Neurophysiol 2008; 119:2396–2404.
Hu Y, Ding Y, Ruan D, et al. Prognostic value of somatosensory-evoked potentials in the surgical management of cervical spondylotic myelopathy. Spine (Phila Pa 1976) 2008; 33:E305–310.
Morishita Y, Hida S, Naito M, et al. Evaluation of cervical spondylotic myelopathy using somatosensory-evoked potentials. Int Orthop 2005; 29:343–346.
Berthier E, Turjman F, Mauguiere F. Diagnostic utility of somatosensory evoked potentials (SEPs) in presurgical assessment of cervical spondylotic myelopathy. Neurophysiol Clin 1996; 26:300–310.
Ganes T. Somatosensory conduction times and peripheral, cervical and cortical evoked-potentials in patients with cervical spondylosis. J Neurol Neurosurg Psychiatry 1980; 43:683–689.
Deletis V, Sala F. Intraoperative neurophysiological monitoring of the spinal cord during spinal cord and spine surgery: A review focus on the corticospinal tracts. Clin Neurophysiol 2008; 119:248–264.
Devlin VJ, Schwartz DM. Intraoperative neurophysiologic monitoring during spinal surgery. J Am Acad Orthop Surg 2007; 15:549–560.
Li X, Li GS, Luk DK, et al. Neurorestoratology evidence in an animal model with cervical spondylotic myelopathy. J Neurorestoratol 2017; 5:21–29.
Cui JL, Mak LG, Luk KC, et al. A combination of functional magnetic resonance imaging and diffusion tensor image to explore structure–function relationship in healthy and myelopathic spinal cord. J Neurorestoratol 2016; 4:69–78.
Robinson LR, Micklesen PJ, Tirschwell DL, et al. Predictive value of somatosensory evoked potentials for awakening from coma. Crit Care Med 2003; 31:960–967.
Wang S, Tian Y, Lin X, et al. Comparison of intraoperative neurophysiologic monitoring outcomes between cervical and thoracic spine surgery. Eur Spine J 2017; 26:2404–2409.
Zuneng L. Practical Electromyography (in Chinese). Beijing: Peoples Medical Publishing House; 2000.
Kerkovsky M, Bednarik J, Dusek L, et al. Magnetic resonance diffusion tensor imaging in patients with cervical spondylotic spinal cord compression: correlations between clinical and electrophysiological findings. Spine (Phila Pa 1976) 2012; 37:48–56.
Dvorak J, Sutter M, Herdmann J. Cervical myelopathy: clinical and neurophysiological evaluation. Eur Spine J 2003; 12: (suppl 2): S181–187.
Ellingson BM, Salamon N, Grinstead JW, et al. Diffusion tensor imaging predicts functional impairment in mild-to-moderate cervical spondylotic myelopathy. Spine J 2014; 14:2589–2597.
Sheikh Taha AM, Shue J, Lebl D, et al. Considerations for prophylactic surgery in asymptomatic severe cervical stenosis: review article. HSS J 2015; 11:31–35.
Matsumoto M, Fujimura Y, Suzuki N, et al. MRI of cervical intervertebral discs in asymptomatic subjects. J Bone Joint Surg Br 1998; 80:19–24.
Mehalic TF, Pezzuti RT, Applebaum BI. Magnetic resonance imaging and cervical spondylotic myelopathy. Neurosurgery 1990; 26:217–226. discussion 226-217.
Grabher P, Mohammadi S, Trachsler A, et al. Voxel-based analysis of grey and white matter degeneration in cervical spondylotic myelopathy. Sci Rep 2016; 6:24636.
Curt A. [Neurological diagnosis and prognosis: significance of neurophysiological findings in traumatic spinal cord lesions]. Schweiz Med Wochenschr 2000; 130:801–810.
Huang H, Sharma HS, Chen L, et al. Review of clinical neurorestorative strategies for spinal cord injury: Exploring history and latest progresses. J Neurorestoratol 2018; 6:171–178.
Yu YL, Jones SJ. Somatosensory evoked potentials in cervical spondylosis. Correlation of median, ulnar and posterior tibial nerve responses with clinical and radiological findings. Brain 1985; 108 (pt 2):273–300.
Veilleux M, Daube JR. The value of ulnar somatosensory evoked potentials (SEPs) in cervical myelopathy. Electroencephalogr Clin Neurophysiol 1987; 68:415–423.
Ganes T. Somatosensory conduction times and peripheral, cervical and cortical evoked potentials in patients with cervical spondylosis. J Neurol Neurosurg Psychiatry 1980; 43:683–689.
Lyu RK, Tang LM, Chen CJ, et al. The use of evoked potentials for clinical correlation and surgical outcome in cervical spondylotic myelopathy with intramedullary high signal intensity on MRI. J Neurol Neurosurg Psychiatry 2004; 75:256–261.
Wang YZ, Li GS, Luk KDK, et al. Component analysis of somatosensory evoked potentials for identifying spinal cord injury location. Sci Rep 2017; 7:2351.