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，其诊断策略尚未建立。我们的目的是建立CSM的诊断策略。为此，我们从以下三个方面进行了研究。1.建立正常人体感诱发电位（SEP）和神经传导检查（NCS）的正常值。2.对可能与脊髓型颈椎病混淆的疾病建立诊断和鉴别诊断方法。3.收集脊髓型颈椎病（CSM）患者的针电极肌电图（NEE）和体感诱发电位（SEP）数据，建立CSM的诊断策略。1.收集65名正常人胫神经SEP数据，并根据身高、年龄等因素建立正常值。揭示了正中神经SEP中N10成分的起源。我们发现了一个新的陷阱，在感觉NCS的前臂外侧皮神经。2.在CTS的顺向感觉型NCS中发现了一个新的陷阱，这是与CSM的重要鉴别诊断。我们报告了日本第一例完全利用电诊断方法的胸骨正中切开术后C8神经丛病变。首席研究员Sonoo发现了一种新的神经学体征“Sonoo征;外展肌征”，这有助于区分腿部的器质性和非器质性轻瘫。我们使用胫神经SEP确定了脊髓痨的初始病变。3.我们收集了120例脊髓型颈椎病患者的肌电图数据，目前正在建立一个肌电图数据库。我们还前瞻性地记录了大约50例CSM病例的中位数和胫骨SEP。分析这些庞大的数据将需要更多的时间。首席研究员Sonoo撰写了许多其他评论文章，并发表了许多关于神经系统疾病电诊断的演讲。

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.