The Diagnostic And Predictive Value Of Neuroelectrophysiology In Cervical Spondylotic Myelopathy

Part ? Diagnostic value of neuroelectrophysiology in cervical spondylotic myelopathy Background:In patients with cervical spondylosis who have cervical spinal cord morphological changes but only mild clinical symptoms,the diagnosis and treatment strategies are still controversial.Objective:In order to provide a basis for clinical diagnosis,neuroelectrophysiological indicators were used to evaluate the neurological function of patients with cervical spinal cord morphological changes but only mild clinical symptoms.Methods:Retrospective analysis From August 2015 to June 2018,both cervical nuclear magnetic MRI and neuroelectrophysiological examination were conducted by inpatients and outpatients of spinal surgery at Shanxi University Hospital.Through the observation of cervical MRI,the patientswho only had the pressure of the spinal cord in the single section of were selected,and according to the degree of classification of the cervical MRI vertebral tube stenosis Kang,they were divided into Group A: Kang graded in patients in patients at level 2,Group B: Kang graded 2 outpatients;Applying the corresponding statistical analysis,the difference symbiotic stozoic indicators between the two groups were observed,and the correlation between Kang grading and neuroelectrophysiologicals was analyzed.Results:Comparing the neuroelectrophysiological test index between two groups of patients in Group A(36 cases)of kang grade 2 and 2 in patients with Kang grade 2,there was no significant difference in the performance of eMG between the two groups from the results of the corresponding muscle EMG in the same spinal cord segment;H reflection comparison,Group A H reflection lead rate of 100%,B group H reflection lead rate of 40%,Group A lead outofsignificant lygout group B,Group A H-reflection Hmax/Mmax wave ratio compared with Group B there is a significant difference,Group A H-reflected Hmax/Mmax wave ratio is higher than Group B;There were significant statistical differences in the ratio of Hmax/Mmax amplitude between Group B,and there was a difference in the abnormality rate of four body sense induced potential SEP in Group A compared with group B,while the neural conduction velocity NCV in Group A was no different from that in Group B.Conclusion:For patients with cervical spondylosis with mild clinical symptoms and spinal cord compression in imaging,neuroelectrophysiological testing can not only provide an important basis for differential diagnosis,but also better assess the situation of nerve damage,and provide a basis for the early diagnosis of cervical spondylosis.Part ? Progression Prediction of Mild Cervical Spondylotic yelopathy by Somatosensory-Evoked PotentialsStudy Design.Retrospective study to correlate classification of somatosensory-evoked potentials(SEPs)with symptomatic progress of patients with mild cervical spondyloticmyelopathy(CSM).Objective.To evaluate the usefulness of SEPs for predicting symptomatic progress of mild CSM.Summary of Background Data: SEPs have been used for clinical diagnosis and intraoperative neuromonitoring in patients with CSM.However,the prognostic value of SEPs in predicting the progression of CSM remains unclear.Methods: A total of 200 patients with a clinical diagnosis of mild CSM were enrolled between September 2014 and February 2018.All patients received clinical assessment with the modified Japanese Orthopedic Association scale(m JOA),magnetic resonance imaging,and SEP tests in the first clinical visit and at 1-year follow-up.A classification of upper and lower limbs SEP was developed.At 1-year follow-up,patients with symptom decline >2 points in m JOA were considered progressive myelopathy cases.The relationship of progressive myelopathy and classifications of SEP was investigated.Results: Fifty-four of 200 cases presented with progressive myelopathy.The incidence of progressive myelopathy was 2.6%,27.7%,23.8%,86.7%,and 100% in Class I,II,III,IV,and V of upper SEPs,respectively,and 18.8%,39.4%,42.3%,and 83.3% in Class I,II,III,and IV of lower SEPs,respectively.For the combination classification of upper and lower SEPs,the incidence of progressive myelopathy was 0%,13.7%,24.3%,91.1%,and 100% in Class I,II,III,IV,and V,respectively.There was a significant correlation of the incidence of progressive myelopathy with SEP classification for the upper SEPs(r=0.94,P<0.01)and the combination SEPs(r=0.95,P<0.01).Conclusion.The incidence of progressive degenerative myelopathy increased with the upper and combination SEP classifications.Thus,classification of SEPs could predict the clinical decline in m JOA in CSM,reflecting the probability of worsening of myelopathy.