Informativeness of neurophysiological diagnostic methods in the differentiation of motor neurons of spinal cord motor neuron disease
Keywords:cervical spondylotic myelopathy, diagnosis, jitter
Objectives: Defining the principles and tactics of differential use of Neurophysiological (NPh) methods in cervical spondilotic myelopathy (CSM) diagnosis.
Materials and methods. Analysis of the clinical and NPh examination data of 160 patients (from 31 to 76 years of age) suffering from CSM. The examination techniques used: clinical and neurological; neurovisualizing (MRI, CT, functional spondylography); a set of NPh methods, namely: stimulation electromyography (ENMG) with F-wave recording (188 examinations); needle EMG (105); motor evoked potentials (MEP) (188); somatosensory evoked potentials (SSEP) (50); single fiber EMG with determination of average density of muscle fibers in motor units and reliability of neuromuscular transmission (32).
Results. An optimal scheme of the use of NPh diagnostic methods in patients with SCM was worked out and applied. Out of the total of 160 patients examined, 19 (11.9%) had motoneuron involved; 32 (20%) had ALS syndrome at the background of cervical spondylosis; 59 (36.9%) patients had concomitant radiculopathy, etc. The sensitivity of MEP technique in the identification of partial spinal cord compression in cervical spondylosis was confirmed – 134 (83.8%) cases; SSEP – 29 (58%). The clinical example illustrates the role of jitter-analysis in the cases when a subtle differentiation between the motoneuronal disease, ischemic and compression injury of the spinal cord motoneurons is necessary.
Conclusions. An optimal scheme of the use of NPh diagnostic methods in patients with CSM was suggested. Due to the use of motor and somatosensory evoked potential techniques, the diagnosis of the spinal cord conduction structures compression and evaluation of the degree of their functional disorders were improved. The use of jitter-analysis allows to increase the information value of NPh diagnosis of the spinal motoneuron involvment, especially at the early stages of the pathological process.
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