Usefulness of CMAP derived from proximal and distal muscles by Erb point stimulation and of CMCT in cervical spondylotic amyotrophy

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  • Igaki Ayumi
    Department of Clinical Laboratory, Hyogo College of Medicine Hospital
  • Okada Fumiaki
    Department of Orthopaedic Surgery, Hyogo College of Medicine
  • Kuroda Miho
    Department of Clinical Laboratory, Hyogo College of Medicine Hospital
  • Inuzumi Koji
    Department of Clinical Laboratory, Hyogo College of Medicine Hospital
  • Koshiba Masahiro
    Department of Clinical Laboratory, Hyogo College of Medicine Hospital Department of Clinical Laboratory Medicine, Hyogo College of Medicine

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  • 頸椎症性筋萎縮症におけるErb点電気刺激による近位筋, 遠位筋のCMAPとCMCTの臨床的有用性について
  • ケイツイショウセイキン イシュクショウ ニ オケル Erbテン デンキ シゲキ ニ ヨル キン イキン,エンイキン ノ CMAP ト CMCT ノ リンショウテキ ユウヨウセイ ニ ツイテ

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Abstract

The cause of the cervical spondylotic amyotrophy (CSA) is thought to be the nerve root damage, the impairment of the anterior horn of spinal cord, or the mixed type of both lesions. In CSA patients, measured were the compound muscle action potentials (CMAP), central motor conduction time (CMCT) and F wave. CMAP stimulated at supramaximal Erb point were recorded from the proximal (deltoid and biceps) and distal muscles (extensor digitorum and abductor digiti minimi). The aim of this study was to determine the clinical usefulness of these electrophysiological tests for the pathophysiological analyses and the prediction of prognosis of CSA patients. Fourteen patients with proximal type CSA and 3 with distal type CSA were examined. CMAP were recorded from the above muscles, while CMCT was calculated from the motor evoked potentials (MEP) and F wave. All of the atrophied muscles showed decreased CMAP amplitude. Not only the affected muscles but also the healthy muscles as well as proximal muscles in distal type CSA patients showed the decreased amplitude. CMAP ratio to the reference value was correlated with manual muscle testing (MMT). Interestingly there found patients with full MMT score whose CMAP amplitudes were decreased. Even in the patients with full MMT, CMAP evoked by Erb point stimulation was able to detect the preclinical abnormalities, and the decrease in CMAP from the several spinal cord segments suggests that wide range of the segments was affected. The delayed CMCT and the F wave abnormalities were found in 36% of proximal type CSA patients and all distal type CSA patients. Furthermore, the patients with postoperative poor prognosis were the cases that myelopathy across a wide range was suggested by preoperative CMCT and F wave abnormalities. Thus, these electrophysiological tests on CSA patients can be useful both in the evaluation of the affected regions and the prediction of the postoperative prognosis.

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