Establishment of evidence-based electrodiagnosis of cervical spondylotic myelopathy

脊髓型颈椎病(CSM)在日本很流行，但与西方国家流行的神经根型颈椎病相比，其诊断策略并不成熟。我们的目标是建立CSM的诊断策略。为此，我们从以下三个方面进行了研究。1.建立体感诱发电位(SEPS)和神经传导研究(NCS)的正常值。2.建立可能与CSM相混淆的疾病的诊断和鉴别诊断方法。3.收集脊髓型颈椎病患者的针状肌电(NEE)和体感诱发电位(SEP)数据，建立CSM的诊断策略。1.收集了65例正常受试者的胫神经SEP数据，并考虑身高、年龄等因素建立了正常值。我们揭示了正中神经SEP中N10成分的来源。我们在前臂外侧皮神经的感觉神经传导系统中发现了一个新的陷阱。2.我们在CTS的顺行感觉NCS中发现了一个新的陷阱，这是与CSM的重要鉴别诊断。我们报告了日本首例胸骨正中切开后C8神经丛病变，充分利用了电诊断方法。首席研究员Sonoo发现了一种新的神经学征兆“Sonoo征；外展肌征”，这对区分器质性和非器质性腿部瘫痪很有用。我们利用胫神经SEPS识别了最初的背阔肌损伤。3.我们收集了大约120例CSM患者的肌电数据，目前正在建立他们的肌电结果数据库。我们还前瞻性地记录了大约50例CSM患者的正中和胫骨SEP。对这些海量数据的分析还需要一些时间。首席研究员Sonoo撰写了许多其他综述文章，并发表了许多关于神经疾病电诊断的讲座。

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.