- 作者：Nobuaki Tadokoro ; Toshikazu Tani ; Masahiko Ikeuchi ; Ryuichi Takemasa ; Kazunobu Kida ; Tatsunori Ikemoto ; Takahiro Ushida ; Shinichirou Taniguchi ; Jun Kimura
- 关键词：Descending spinal cord evoked potential ; D-wave ; Referential recording ; Transcranial electrical stimulation ; Conduction block
- 刊名：Clinical Neurophysiology
- 出版年：January, 2014
- 年：2014
- 卷：125
- 期：1
- 页码：202-207
- 全文大小：979 K
Objectives
To characterize waveform changes of descending spinal cord evoked potentials (D-SCEPs) seen in cervical spondylotic myelopathy (CSM).Methods
Intraoperative D-SCEP recording from serial intervertebral discs after transcranial electrical stimulation in 19 CSM patients with cord compression at a single level.
Results
Compared to the baseline (100%) obtained one level rostrally, the D-SCEP recorded at the compression site showed a significantly (p < 0.001) decreased amplitude (48%) and area (48%) of negative peak and increased amplitude (171%) and area (279%) of initial-positive peak. The degree in reduction of negative peak remained the same irrespective of the cord level involved, whereas enhancement of the positive peak tended to diminish with a more caudal compression.
Conclusions
In intraoperative electrophysiological studies of CSM with D-SCEP, an abrupt reduction of the negative peak accompanied by an enhancement of the initial-positive peak helps identify the site of conduction block. We speculate that progressive loss of the descending motor volleys at the synapses in the cervical enlargement may account for limited or absent enhancement of positive peak seen caudally.
Significance
The current finding helps us understand the pros and cons of various electrophysiologic techniques for intraoperative localization of maximal cord involvement in CSM.