Neurophysiological changes in long tracts in chronic cervical cord compression
Neurophysiological changes in long tracts in chronic cervical cord compression
A group of 38 patients with Cervical Spondylosis Myelopathy (CSM) who were selected for surgery were studied using a full range of neurophysiological and functional tests prior to surgery. 11 patients were studied again at 1 month and 17 at 6 months post operatively. The aim was to illustrate in detail the pathophysiology of the condition and to determine any useful points for clinical practice.
The long motor and sensory pathways to and from the lumbo-sacral cord are affected early, and abnormalities are more common in motor than sensory modalities. Abnormalities sometimes precede the development of the Babinski sign.
Motor pathways to the arm muscles show less abnormality, even though the motor tracts are in the vicinity of the cord compression. The motor pathways to the small hand muscles show abnormal conduction time in 79% of cases. In CSM patients the corticospinal tracts to tibialis anterior are more likely to be affected (82%).
Physiological abnormalities develop before any signal change is seen within the cord on MRI. Abnormalities of gait appear late but manipulative function shown by the Nine-Hole Peg Test (9HPT) is affected early.
Points for clinical practice are: 1) Motor Conduction time to Tibialis Anterior is the most sensitive and along with MCT to hand muscles are more useful than Posterior Tibial SEP's. 2) There is little or no neurophysiological improvement post operatively. 3) 9HPT, Nurick and hand function tests are less sensitive in diagnosis than electrophysiological tests. 4) Post-operatively improvement can be observed on functional testing more than with electrophysiological tests i.e. 9HPT, Nurick and Hand function. 5) The 10-Metre Walking Test (10MWT) and Japanese Orthopaedic Association (JOA) were less sensitive. 6) MRI signal change is a relatively late development.
University of Southampton
1998
Azadeh, Hamid
(1998)
Neurophysiological changes in long tracts in chronic cervical cord compression.
University of Southampton, Doctoral Thesis.
Record type:
Thesis
(Doctoral)
Abstract
A group of 38 patients with Cervical Spondylosis Myelopathy (CSM) who were selected for surgery were studied using a full range of neurophysiological and functional tests prior to surgery. 11 patients were studied again at 1 month and 17 at 6 months post operatively. The aim was to illustrate in detail the pathophysiology of the condition and to determine any useful points for clinical practice.
The long motor and sensory pathways to and from the lumbo-sacral cord are affected early, and abnormalities are more common in motor than sensory modalities. Abnormalities sometimes precede the development of the Babinski sign.
Motor pathways to the arm muscles show less abnormality, even though the motor tracts are in the vicinity of the cord compression. The motor pathways to the small hand muscles show abnormal conduction time in 79% of cases. In CSM patients the corticospinal tracts to tibialis anterior are more likely to be affected (82%).
Physiological abnormalities develop before any signal change is seen within the cord on MRI. Abnormalities of gait appear late but manipulative function shown by the Nine-Hole Peg Test (9HPT) is affected early.
Points for clinical practice are: 1) Motor Conduction time to Tibialis Anterior is the most sensitive and along with MCT to hand muscles are more useful than Posterior Tibial SEP's. 2) There is little or no neurophysiological improvement post operatively. 3) 9HPT, Nurick and hand function tests are less sensitive in diagnosis than electrophysiological tests. 4) Post-operatively improvement can be observed on functional testing more than with electrophysiological tests i.e. 9HPT, Nurick and Hand function. 5) The 10-Metre Walking Test (10MWT) and Japanese Orthopaedic Association (JOA) were less sensitive. 6) MRI signal change is a relatively late development.
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Published date: 1998
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Local EPrints ID: 463278
URI: http://eprints.soton.ac.uk/id/eprint/463278
PURE UUID: 650a6650-4a33-4deb-bb67-a5eace312d7e
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Date deposited: 04 Jul 2022 20:48
Last modified: 04 Jul 2022 20:48
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Author:
Hamid Azadeh
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