Localization of the primary sites of involvement in the spinal sensory and motor pathways for multilevel MRI abnormalities in degenerative cervical myelopathy
Localization of the primary sites of involvement in the spinal sensory and motor pathways for multilevel MRI abnormalities in degenerative cervical myelopathy
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退行性脊髓型颈椎病多级 MRI 异常的脊髓感觉和运动通路主要受累部位的定位
DOI：
10.1038/s41393-017-0011-9
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发表时间：
2017
期刊：
影响因子：
2.2
通讯作者：
M. Ikeuchi
中科院分区：
文献类型：
--
作者：
N. Tadokoro;T. Tani;K. Kida;Katsuhito Kiyasu;Yusuke Kasai;M. Kumon;R. Takemasa;M. Ikeuchi
研究设计探索性临床研究。目的定位脊髓感觉和运动通路中的传导阻滞部位，以最大限度地减少手术干预的水平，尽管MRI证据表明退行性颈椎病（DCM）在几个水平存在压迫。设置高知医学院医院，我们分析了83例DCM患者，（69 ± 12岁），接受了上行（A-SCEP）和下行脊髓诱发电位（D-SCEP）的连续椎间记录分别在硬膜外和经颅刺激后，在减压手术前的手术期间。传导阻滞的部位通过负峰的突然减少伴随着初始正峰的扩大来确定。T1加权磁共振成像允许定量评估脊髓压迫的水平conduction block.ResultsThe A-SCEP和D-SCEP研究显示在同一个单一的水平在78例（94%），并在两个单独的水平在5例（6%）的MRI异常延伸到3.1 ± 1.1水平的传导阻滞。传导阻滞的部位在MRI上有强烈的脊髓压迫，脊髓的前后径和横截面积最小（81%）或第二小（19%）。根据SCEP结果，44例患者接受单节段（35例）或双节段（9例）前路手术治疗，MRI异常水平为2.7 ± 1.1个节段。在34例前路手术患者中，该方法有助于排除临床上无症状的压迫，以减少手术干预。
Study designExploratory clinical study.ObjectivesTo localize the sites of conduction block in the spinal sensory and motor pathways for minimizing the level of surgical intervention despite MRI evidence of compression at several levels in degenerative cervical myelopathy (DCM).SettingKochi Medical School Hospital, Japan.MethodsWe analyzed 83 DCM patients (69 ± 12 years) who underwent serial intervertebral recording of both ascending (A-SCEPs) and descending spinal cord-evoked potentials (D-SCEPs) after epidural and transcranial stimulation, respectively, during surgery before decompression procedures. The site of conduction block was identified by an abrupt reduction of the negative peak accompanied by an enlargement of the initial-positive peak. T1-weighted MRI allowed quantitative assessments of cord compression in relation to the level of conduction block.ResultsThe A-SCEP and D-SCEP studies revealed conduction blocks at the same single level in 78 patients (94%) and at two separate levels in five patients (6%) for MRI abnormalities extending to 3.1 ± 1.1 levels. The site of conduction block had intense cord compression on MRI with either the smallest (81%) or the second smallest (19%) anteroposterior diameter and cross-sectional area of the cord. Based on the SCEP findings, 44 patients were treated by a single-level (35) or a two-level (9) anterior operation for MRI abnormalities of 2.7 ± 1.1 levels.ConclusionsCombined A-SCEP and D-SCEP studies served as useful additions to MRI in localizing the primary sites responsible for myelopathy, which helped exclude clinically silent compressions to minimize surgical intervention in 34 patients with anterior operation.