دراسة الجهد البدني - الحسي المثار في مرضى اعتلال النخاع الناتج عن داء الفقار الرقبية == Somatosensory Evoked Potentials Study in Cervical Spondylotic Myelopathy Patients
Author name:
رؤى محمد كريم
General topic:
Medicine
Specific topic:
Physiology
Degree:
Master
University:
University of Baghdad - Faculty Of Medicine
Language:
English
University location:
Baghdad
First pages:
19T1337 - p.pdf
Abstract:
Cervical spondylotic myelopathy (CSM) is considered the most serious consequence of cervical spondylosis and accounts for the majority of non_traumatic paraparesis and/or quadriparesis. The electrical property of the spinal cord and its susceptibility to injuries renders electrophysiology relevant to the management of CSM. SEPs study is an objective assessment of the functional integrity of the neural pathway.With the introduction of MRI, increasing numbers of cases are identified where spondylotic changes and disc herniation reach and compress the cervical spinal cord; however, the significance of these radiological findings with respect to the development of myelopathy is unclear.It is recommended that preoperative sensory - evoked potentials may be considered for patients with CSM in whom clinical factors do not provide clear guidance and would potentially change therapeutic decisions.In this study 22 patients with CSM (11 male and 11 female) and matched with 25 subjects of the control group were enrolled. All subjects were tested with bilateral SNCV of median and sural nerves and with bilateral median and tibial SSEPs tests. Results of SSEPs studies show 19(86.36%) out of 22 patients had abnormal SSEPs study (either tibial or median or both tests abnormal), with 68.2% abnormal tibial and 63.6% abnormal median study. There was no difference between median and tibial SSEPs results in patients (P>0.05) and most of the abnormalities were bilateral and there was no difference between right and left side study of neither median nor tibial SSEPs studies (P>0.05).Median SSEPs showed that abnormality in cortical response N20 and cervical spinal potential N13 compared to control group were highly significant (P<0.0005). Also IPLs were significant regarding (N9 - N13), (N9 - N20), (P14 - N20) and (N13 - N20) with (N13 - N20) was the most significant with 63.6% right and 54.5% left side abnormality. Abnormal cortical response (P37) following tibial stimulation was highly significant compared to control group (P<0.0005) with 14 cases (63.6%) abnormal bilateral tibial SSEPs and 1 patient with unilateral right tibial SSEPs abnormality. Abnormal tibial SSEPs associated with slightly more frequent loss of components than delayed responses. IPL (LP - P37) was highly significant (P<0.0005) with 68.2% right and 63.6% left abnormal results. Patients were classified clinically according to Nurick grading system of cervical myelopathy. Four out of 8 cases with normal median SSEPs of the patients were grade - 1 Nurick, 5 out of 7 cases with normal tibial SSEPs of patients were grade - 1 and 3 out of total 22 patients had normal both median and tibial SSEPs were all grade - 1 and this suggests that normal SSEPs findings mostly correlate with mild and early myelopathy. Six out of 10 cases with abnormal both median and tibial SSEPs were grade - 1 and grade - 2(2 cases grade1 and 4cases grade - 2) and this suggests that abnormal SSEPs findings are useful in prediction the progression of myelopathy in patients with mild clinical neurological deficits in the early stages of the disease.This study concluded that both median and tibial SSEPs montages should be performed to evaluate patients with CSM as the progression of the cervical cord compression may take variable pathways. MRI and SEPs may evaluate different aspects of the disease process; therefore, SEPs study is a useful important objective assessment of the spinal cord function
