Establishment of evidence-based electrodiagnosis of cervical spondylotic myelopathy

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Cervical spondylotic myelopathy (CSM) is popular in Japan but its diagnostic strategy is not well established compared to the cervical spondylotic radiculopathy that is popular in western countries. We aimed to establish the diagnostic strategy of CSM. For this purpose we made researches regarding the following three aspects. 1.To establish the normal values for somatosensoy evoked potentials (SEPs) and nerve conduction studies (NCS). 2.To establish methods of diagnosis and differential diagnosis for diseases that may be confusing with CSM. 3.To collect the needle electromyography (NEE) and SEP data of CSM patients and to establish the diagnostic strategy of CSM.We achieved the following results while supported by this grant. 1.We collected tibial nerve SEP data of 65 control subjects and established normal values considering subject factors, such as height or age. We revealed the origin of N10 component in median nerve SEPs. We found a new pitfall in sensory NCS in lateral antebrachial cutaneous nerve. 2.We found a new pitfall in the orthodromic sensory NCS in CTS, an important differential diagnosis with CSM. We reported the first case in Japan of postmedian sternotomy C8 plexopathy fully utilizing electrodiagnostic method. The head investigator Sonoo discovered a new neurological sign "Sonoo sign ; abductor sign", which is useful in discriminating between organic and non-organic paresis of a leg. We identified the initial lesion of tabes dorsalis using tibial nerve SEPs. 3.We collected EMG data for around 120 CSM cases and are now constructing a database of their EMG findings. We also prospectively recorded median and tibial SEPs for around 50 CSM cases. Analysis of these vast data will take some more time. The head investigator Sonoo wrote many other review articles and delivered many lectures regarding electrodiagnosis of neurological diseases.