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  • Title: Transcranial magnetic stimulation in the diagnosis of cervical compressive myelopathy: comparison with spinal cord evoked potentials.
    Author: Funaba M, Kanchiku T, Imajo Y, Suzuki H, Yoshida Y, Nishida N, Taguchi T.
    Journal: Spine (Phila Pa 1976); 2015 Feb 01; 40(3):E161-7. PubMed ID: 25384053.
    Abstract:
    STUDY DESIGN: Single-center retrospective study. OBJECTIVE: To reveal the characteristic changes in central motor conduction time (CMCT) produced by transcranial magnetic stimulation among the responsible levels of cervical compressive myelopathy (CCM). SUMMARY OF BACKGROUND DATA: CMCT is a useful and noninvasive measure for evaluating the central motor pathway. However, a systematic correlation between CMCT findings and the responsible level of CCM has so far not been addressed in a large patient cohort. METHOD: We measured CMCT in 75 patients with CCM who were determined by intraoperative spinal cord evoked potentials to have a single site of conduction abnormality at the intervertebral level. Twenty-one healthy controls were also evaluated. Motor evoked potentials, compound muscle action potentials, and F wave were recorded from bilateral abductor digiti minimi (ADM) and abductor hallucis (AH) muscles. CMCT was calculated as follows: motor evoked potentials latency-(CMAPs latency+F latency-1)/2 (ms). RESULT: The mean values of ADM-CMCT and AH-CMCT at each responsible level were significantly longer than those of normal values (P<0.01). However, the mean value of ADM-CMCT at the C6-C7 level was markedly shorter than those at the other levels, whereas the mean values of AH-CMCT were not significantly different between each responsible level. We determined that an ADM-CMCT longer than 7.9 ms (mean+2.5 standard deviation) was abnormal. Using this definition, the sensitivity of ADM-CMCT for CCM was 92% for C3-C4 myelopathy, 95% for C4-C5, 58% for C5-C6, and 9% for C6-C7. CONCLUSION: ADM-CMCT is useful for the screening of CCM rostral to the C5-C6 level. Diagnosis of patients with C6-C7 myelopathy should include assessment of the AH-CMCT. LEVEL OF EVIDENCE: 4.
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