Abstract
Study design:
A retrospective study.
Objective:
To elucidate the correlation between compound muscle action potentials (CMAPs) amplitudes and responsible level of compressive cervical myelopathy (CCM), and the accuracy of level diagnosis by using CMAPs.
Setting:
This study was conducted at the Department of Orthopedic surgery, Yamaguchi University Graduate School of Medicine, Japan.
Method:
A total of 28 patients with CCM were investigated in this study. Erb’s point-stimulated CMAPs were measured from deltoid, biceps, triceps in all patients as compared with 88 healthy subjects. We performed a level diagnosis on the basis of CMAPs amplitudes. We performed a level diagnosis on the basis of CMAPs amplitudes and using an index that measures the deviation of CMAPs amplitudes between triceps and deltoid or biceps.
Results:
Significant correlations between the mean CMAPs amplitudes and responsible level were showed for deltoid (6.82±2.33 mV) at C3/4 (P<0.01) and biceps (8.75±4.42 mV) at C4/5 (P=0.015). Despite considerable individual variability in CMAP amplitudes, there were correlations among CMAPs amplitudes for deltoid, biceps and triceps in the same individual. The sensitivity was 75.0%, specificity 75.0% in the index for diagnosis of C3/4. The sensitivity was 75.0%, specificity 66.7% in the index for diagnosis of C4/5.
Conclusion:
This study showed small CMAPs amplitudes in the deltoid indicated a C3/4 level of myelopathy and in biceps at the C4/5 level and could help exclude clinically silent cord compression and determine the surgical procedure to the suitable level of concern.
Similar content being viewed by others
Log in or create a free account to read this content
Gain free access to this article, as well as selected content from this journal and more on nature.com
or
References
Satomi K, Okuma T, Kenmotsu K, Nakamura Y, Hirabayashi K . Level diagnosis of cervical myelopathy using evoked spinal cord potentials. Spine 1988; 13: 1217–1224.
Shinomiya K, Furuya K, Sato R, Okamoto A, Kurosa Y, Fuchioka M . Electrophysiologic diagnosis of cervical OPLL myelopathy using evoked spinal cord potentials. Spine 1988; 13: 1225–1233.
Imajo Y, Kato Y, Kanchiku T, Suzuki H, Taguchi T . Pathology and prognosis of proximal-type cervical spondylotic amyotrophy: New assessment using compound muscle action potentials of deltoid and biceps brachii muscles. Spine 2011; 36: E476–E481.
Kaneko K, Kawai S, Taguchi T . Correlation between spinal cord compression and abnormal pattern of median nerve somatosensory evoked potentials on compressive cervical myelopathy: common of surface and epidurally recorded response. J Neurol Sci 1998; 158: 193–202.
Kanchiku T, Taguchi T, Kaneko K, Fuchigami Y, Yonemura H, Kawai S . A correlation between magnetic resonance imaging and electrophysiological findings in cervical spondylotic myelopathy. Spine 2001; 26: 269–274.
Kaneko K, Taguchi T, Kawai S . Mechanism of postoperative C5 paralysis in cervical myelopathy: An investigation based on nerve root distribution to the deltoid and biceps brachii muscles. Rinsyo Seikei Geka 2003, 383–387.
Yonemura H, Kaneko K, Taguchi T, Fujimoto H, Toyoda K, Kawai S . Nerve root distribution of deltoid and biceps brachii muscle in cervical spondylotic myelopathy: A potential risk factor for postoperative shoulder muscle weakness after posterior decompression. J Orthop Sci 2004; 9: 540–544.
Kuntzer T, Melle G, Regli F . Clinical and prognostic feature in unilateral femoral neuropathies. Muscle Nerve 1997; 20: 205–211.
Ito T, Oyanagi K, Takahashi H, Takahashi HE, Ikuta F . Cervical sponsylotic myelopathy, clinicophathologic study on the progression pattern and thin myelinated fibers on the lesion of seven patients examined during complete autopsy. Spine 1996; 21: 827–833.
Imajo Y, Kato Y, Yonemura H, Kanchiku T, Suzuki H, Taguchi T . Relative vulnerability of various spinal tracts in C3-4 cervical spomdylotic myelopathy: multi-modal spinal cord evoked potentials. Spinal cord 2011; 49: 1128–1133.
Seichi A, Takeshita K, Kawaguchi H, Matsudaira K, Higashikawa A, Ogata N et al. Neurologic level diagbosis of cervical stenotic myelopathy. Spine 2006; 31: 1338–1343.
Tsuzuki N, Honda H, Tanaka Y . Morphological variation of human cervical spine cord segments and roots and their clinical significance. Orthop Surg 1983; 34: 329–335.
Sharrard WJW . The distribution of the permanent paralysis in the lower limb in poliomyelitis. A clinical and pathological study. J Bone Joint Surg(Br) 1955; 37: 540–558.
Wee AS . Correlation between the biceps brachii muscle bulk and the size of its evoked compound muscle action potentials. Electromyogr Clin Neurophysiol 2006; 46: 79–82.
Tani T, Kishimoto H, Tsuboya H, kimura J . Electrophysiologic assessment of shoulder girdle weakness in patients with cervical spondylosis: prognostic value of supraclavicular stimulation. J Clin Neuromusc Dis 2002; 4: 11–18.
Holzbaur KR, Murray WM, Gold GE, Delp SL . Upper limb muscle volumes in adult subjects. J Biomech 2007; 40: 742–749.
Tani T, Ushida T, Taniguchi S, Kimura J . Age related shift in the primary sites of involvement in cervical spondylotic myelopathy from lower to upper levels. J Neurol Neurosurg Psychiatry 2002; 73: 316–318.
Tani T, Yamamoto H, Kimura J . Cervical spondylotic myelopathy in elderly people: a high incidence of conduction block at C3-4 or C4-5. J Neurol Neurosurg Psychiatry 1999; 66: 456–464.
Azuma Y, Kato Y, Taguchi T . Etiology of cervical myelopathy induced by ossification of the posterior longitudinal ligament. Determining the responsible level of OPLL myelopathy by correlating static compression and dynamic factor. J Spinal Disord Tech 2010; 23: 166–169.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Competing interests
The authors declare no conflict of interest.
Rights and permissions
About this article
Cite this article
Funaba, M., Kanchiku, T., Imajo, Y. et al. Preoperative diagnosis of the responsible level in CCM using CMAPs: comparison with SCEPs. Spinal Cord 52, 191–196 (2014). https://doi.org/10.1038/sc.2013.149
Received:
Revised:
Accepted:
Published:
Issue date:
DOI: https://doi.org/10.1038/sc.2013.149
Keywords
This article is cited by
-
Resting-state functional magnetic resonance imaging indices are related to electrophysiological dysfunction in degenerative cervical myelopathy
Scientific Reports (2024)
-
Preoperative factors that predict fair outcomes following surgery in patients with proximal cervical spondylotic amyotrophy. A retrospective study
Spinal Cord (2020)
