DOI: https://doi.org/10.22263/2312-4156.2024.2.41
I.S. Khomushka, I.A. Ilyasevich, A.N. Mazurenko
Neurophysiological diagnosis of spinal cord disorders in vertebrogenic cervical myelopathy
Republican Scientific and Practical Centre of Traumatology and Orthopedics, Minsk, Republic of Belarus
Vestnik VGMU. 2024;23(2):41-50.
Abstract.
The problem of diagnosing the level and extent of neurologic disorders in patients with vertebrogenic cervical myelopathy remains relevant.
Objectives. To determine the informativeness of neurophysiological criteria in the evaluation of spinal cord disorders in patients with vertebrogenic cervical myelopathy.
Material and methods. At the stage of preoperative preparation, 103 patients with degenerative multisegmental stenosis of the cervical section of the vertebral canal were examined by the clinical, radiological and neurophysiological methods. The neurophysiological study included methods of surface electromyography, nerve conduction study, registration of the motor response of muscles under the exposure of transcranial magnetic stimulation.
Results. According to the analysis results of clinical, radiological and neurophysiological data, patients (n=51) with the signs of myelopathy were singled out among those who suffered from multisegmental cervical stenosis (n=103). Surface electromyography in patients with myelopathy revealed the signs of general and asymmetric (by 40-90%) decrease in the amplitude of bioelectric activity of the upper limb muscles, in 25% there were signs of structure changes indicating the lesion of motor neurons in the anterior horns. The analysis of F-wave data showed a decrease in its amplitude in 56% of subjects, in 48% – prolongation of the impulse conduction time on the proximal region of the peripheral nerve. On transcranial magnetic stimulation, patients with cervical myelopathy were divided into three groups depending on the predominant localization of focal lesions (group I – C3-C4; group II – C5-C6 and group III – C6-C7). Statistically significant elongation of the latent time of cortical motor responses of the hand muscles and central motor conduction time in patients in each of the three groups was revealed.
Conclusions. Complex neurophysiological study is an informative and reasonable method of differentiated assessment of spinal and radicular lesions of cervical segments of the spinal cord, as well as identification of subclinical signs of neurological disorder, which determines the choice of optimal treatment tactics in vertebrogenic cervical myelopathy.
Keywords: neurophysiological methods, spinal cord, muscle, myelopathy, transcranial magnetic stimulation, spinal stenosis.
Acknowledgements. The authors express their gratitude to the anonymous reviewers for the time dedicated to their scientific article.
Source of financing. The research was carried out within the frames of the State Research Program (GPNI) “Basic and Applied Sciences – to Medicine”, subprogram “Diagnosis and Therapy of Diseases”, task 2.103 “To establish quantitative electrophysiological criteria for the degree of spinal cord functions impairments in polysegmental stenosis of the cervical spine”, State Registration No. 20190454.
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Information about authors:
I.S. Khomushka – postgraduate, senior research officer of the Сlinical Electrophysiology Laboratory, Republican Scientific and Practical Centre of Traumatology and Orthopedics, http://orcid.org/0000-0001-9649-134X,
E-mail: Этот адрес электронной почты защищён от спам-ботов. У вас должен быть включен JavaScript для просмотра. – Irina S. Khomushka;
I.A. Ilyasevich – Doctor of Biological Sciences, associate professor, head of the Сlinical Electrophysiology Laboratory, Republican Scientific and Practical Centre of Traumatology and Orthopedics;
A.N. Mazurenka – Candidate of Medical Sciences, associate professor, head of the neurosurgery department No. 2, Republican Scientific and Practical Centre of Traumatology and Orthopedics.
