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Journal of Neurology, Neurosurgery, and Psychiatry logoLink to Journal of Neurology, Neurosurgery, and Psychiatry
. 1999 Apr;66(4):456–464. doi: 10.1136/jnnp.66.4.456

Cervical spondylotic myelopathy in elderly people: a high incidence of conduction block at C3-4 or C4-5

T Tani 1, H Yamamoto 1, J Kimura 1
PMCID: PMC1736286  PMID: 10201416

Abstract

OBJECTIVES—To precisely localise the site of conduction block in elderly patients with cervical spondylotic myelopathy in the presence of multilevel compression shown by MRI.
METHODS—A total of 44 patients aged 65 and older underwent serial intervertebral recording of spinal somatosensory evoked potentials (SSEPs) from either the intervertebral disc or the ligamentum flavum after epidural stimulation. The site of conduction block identified by abrupt reduction in size of the negative peak was designated as the 0 level with the other levels numbered in order of distance assigning a minus sign caudally.
RESULTS—A single site of focal conduction block was disclosed in 42 patients, 23 (55%) at C3-4, 17 (40%) at C4-5, and two (5%) at C5-6. At these levels (0), the amplitude of the negative component was reduced (p<0.0001) to 29% and the area to 22%, with a concomitant increase (p<0.0001) of the initial positive component to 150% in amplitude and 293% in area as compared to the−2 level which was taken as the baseline (100%).
CONCLUSIONS—A high incidence (95%) of focal conduction block at C3-4 or C4-5 with normal conduction at C5-6 and C6-7 characterises cervical spondylotic myelopathy in elderly people. Incremental SSEP studies documenting the site of conduction block will help exclude clinically silent cord compression, directing the surgical intervention to the appropriate level of concern.



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Selected References

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  1. Al-Mefty O., Harkey L. H., Middleton T. H., Smith R. R., Fox J. L. Myelopathic cervical spondylotic lesions demonstrated by magnetic resonance imaging. J Neurosurg. 1988 Feb;68(2):217–222. doi: 10.3171/jns.1988.68.2.0217. [DOI] [PubMed] [Google Scholar]
  2. Arnold H., Feldmann U., Missler U. Chronic spondylogenic cervical myelopathy. A critical evaluation of surgical treatment after early and long-term follow-up. Neurosurg Rev. 1993;16(2):105–109. doi: 10.1007/BF00258239. [DOI] [PubMed] [Google Scholar]
  3. Barnes M. P., Saunders M. The effect of cervical mobility on the natural history of cervical spondylotic myelopathy. J Neurol Neurosurg Psychiatry. 1984 Jan;47(1):17–20. doi: 10.1136/jnnp.47.1.17. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Boden S. D., McCowin P. R., Davis D. O., Dina T. S., Mark A. S., Wiesel S. Abnormal magnetic-resonance scans of the cervical spine in asymptomatic subjects. A prospective investigation. J Bone Joint Surg Am. 1990 Sep;72(8):1178–1184. [PubMed] [Google Scholar]
  5. Braakman R. Management of cervical spondylotic myelopathy and radiculopathy. J Neurol Neurosurg Psychiatry. 1994 Mar;57(3):257–263. doi: 10.1136/jnnp.57.3.257. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Cornblath D. R., Sumner A. J., Daube J., Gilliat R. W., Brown W. F., Parry G. J., Albers J. W., Miller R. G., Petajan J. Conduction block in clinical practice. Muscle Nerve. 1991 Sep;14(9):869–868. doi: 10.1002/mus.880140913. [DOI] [PubMed] [Google Scholar]
  7. Crandall P. H., Batzdorf U. Cervical spondylotic myelopathy. J Neurosurg. 1966 Jul;25(1):57–66. doi: 10.3171/jns.1966.25.1.0057. [DOI] [PubMed] [Google Scholar]
  8. Di Lazzaro V., Restuccia D., Colosimo C., Tonali P. The contribution of magnetic stimulation of the motor cortex to the diagnosis of cervical spondylotic myelopathy. Correlation of central motor conduction to distal and proximal upper limb muscles with clinical and MRI findings. Electroencephalogr Clin Neurophysiol. 1992 Oct;85(5):311–320. doi: 10.1016/0168-5597(92)90107-m. [DOI] [PubMed] [Google Scholar]
  9. FRIEDENBERG Z. B., MILLER W. T. DEGENERATIVE DISC DISEASE OF THE CERVICAL SPINE. J Bone Joint Surg Am. 1963 Sep;45:1171–1178. [PubMed] [Google Scholar]
  10. Goodridge A. E., Feasby T. E., Ebers G. C., Brown W. F., Rice G. P. Hand wasting due to mid-cervical spinal cord compression. Can J Neurol Sci. 1987 Aug;14(3):309–311. doi: 10.1017/s0317167100026688. [DOI] [PubMed] [Google Scholar]
  11. Halonen J. P., Jones S. J., Edgar M. A., Ransford A. O. Conduction properties of epidurally recorded spinal cord potentials following lower limb stimulation in man. Electroencephalogr Clin Neurophysiol. 1989 May-Jun;74(3):161–174. doi: 10.1016/0013-4694(89)90002-3. [DOI] [PubMed] [Google Scholar]
  12. Hayashi H., Okada K., Hamada M., Tada K., Ueno R. Etiologic factors of myelopathy. A radiographic evaluation of the aging changes in the cervical spine. Clin Orthop Relat Res. 1987 Jan;(214):200–209. [PubMed] [Google Scholar]
  13. Hayashi H., Okada K., Hashimoto J., Tada K., Ueno R. Cervical spondylotic myelopathy in the aged patient. A radiographic evaluation of the aging changes in the cervical spine and etiologic factors of myelopathy. Spine (Phila Pa 1976) 1988 Jun;13(6):618–625. [PubMed] [Google Scholar]
  14. Hukuda S., Mochizuki T., Ogata M., Shichikawa K., Shimomura Y. Operations for cervical spondylotic myelopathy. A comparison of the results of anterior and posterior procedures. J Bone Joint Surg Br. 1985 Aug;67(4):609–615. doi: 10.1302/0301-620X.67B4.4030860. [DOI] [PubMed] [Google Scholar]
  15. Jaskolski D. J., Jarratt J. A., Jakubowski J. Clinical evaluation of magnetic stimulation in cervical spondylosis. Br J Neurosurg. 1989;3(5):541–548. doi: 10.3109/02688698909002845. [DOI] [PubMed] [Google Scholar]
  16. Jeffreys R. V. The surgical treatment of cervical myelopathy due to spondylosis and disc degeneration. J Neurol Neurosurg Psychiatry. 1986 Apr;49(4):353–361. doi: 10.1136/jnnp.49.4.353. [DOI] [PMC free article] [PubMed] [Google Scholar]
  17. Jones S. J., Edgar M. A., Ransford A. O. Sensory nerve conduction in the human spinal cord: epidural recordings made during scoliosis surgery. J Neurol Neurosurg Psychiatry. 1982 May;45(5):446–451. doi: 10.1136/jnnp.45.5.446. [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. Kimura J., Sakimura Y., Machida M., Fuchigami Y., Ishida T., Claus D., Kameyama S., Nakazumi Y., Wang J., Yamada T. Effect of desynchronized inputs on compound sensory and muscle action potentials. Muscle Nerve. 1988 Jul;11(7):694–702. doi: 10.1002/mus.880110705. [DOI] [PubMed] [Google Scholar]
  19. Kimura J. The carpal tunnel syndrome: localization of conduction abnormalities within the distal segment of the median nerve. Brain. 1979 Sep;102(3):619–635. doi: 10.1093/brain/102.3.619. [DOI] [PubMed] [Google Scholar]
  20. Lunsford L. D., Bissonette D. J., Zorub D. S. Anterior surgery for cervical disc disease. Part 2: Treatment of cervical spondylotic myelopathy in 32 cases. J Neurosurg. 1980 Jul;53(1):12–19. doi: 10.3171/jns.1980.53.1.0012. [DOI] [PubMed] [Google Scholar]
  21. Machida M., Weinstein S. L., Yamada T., Kimura J. Spinal cord monitoring. Electrophysiological measures of sensory and motor function during spinal surgery. Spine (Phila Pa 1976) 1985 Jun;10(5):407–413. [PubMed] [Google Scholar]
  22. Maertens de Noordhout A., Remacle J. M., Pepin J. L., Born J. D., Delwaide P. J. Magnetic stimulation of the motor cortex in cervical spondylosis. Neurology. 1991 Jan;41(1):75–80. doi: 10.1212/wnl.41.1.75. [DOI] [PubMed] [Google Scholar]
  23. Matsuda H., Kondo M., Hashimoto T., Miyawaki Y., Shimada N., Yoshimura M., Shimazu A. The prediction of the surgical prognosis of the compression myelopathy. The study by the descending evoked spinal cord potential. Osaka City Med J. 1984 Dec;30(2):91–112. [PubMed] [Google Scholar]
  24. McDonald W. I., Sears T. A. The effects of experimental demyelination on conduction in the central nervous system. Brain. 1970;93(3):583–598. doi: 10.1093/brain/93.3.583. [DOI] [PubMed] [Google Scholar]
  25. Nurick S. The pathogenesis of the spinal cord disorder associated with cervical spondylosis. Brain. 1972;95(1):87–100. doi: 10.1093/brain/95.1.87. [DOI] [PubMed] [Google Scholar]
  26. Ono K., Ebara S., Fuji T., Yonenobu K., Fujiwara K., Yamashita K. Myelopathy hand. New clinical signs of cervical cord damage. J Bone Joint Surg Br. 1987 Mar;69(2):215–219. doi: 10.1302/0301-620X.69B2.3818752. [DOI] [PubMed] [Google Scholar]
  27. Pelosi L., Caruso G., Cracco R. Q., Cracco J. B., Balbi P. Intraoperative recordings of spinal somatosensory evoked potentials to tibial nerve and sural nerve stimulation. Muscle Nerve. 1991 Mar;14(3):253–258. doi: 10.1002/mus.880140309. [DOI] [PubMed] [Google Scholar]
  28. Restuccia D., Valeriani M., Di Lazzaro V., Tonali P., Mauguière F. Somatosensory evoked potentials after multisegmental upper limb stimulation in diagnosis of cervical spondylotic myelopathy. J Neurol Neurosurg Psychiatry. 1994 Mar;57(3):301–308. doi: 10.1136/jnnp.57.3.301. [DOI] [PMC free article] [PubMed] [Google Scholar]
  29. Rowland L. P. Surgical treatment of cervical spondylotic myelopathy: time for a controlled trial. Neurology. 1992 Jan;42(1):5–13. doi: 10.1212/wnl.42.1.5. [DOI] [PubMed] [Google Scholar]
  30. Satomi K., Okuma T., Kenmotsu K., Nakamura Y., Hirabayashi K. Level diagnosis of cervical myelopathy using evoked spinal cord potentials. Spine (Phila Pa 1976) 1988 Nov;13(11):1217–1224. doi: 10.1097/00007632-198811000-00003. [DOI] [PubMed] [Google Scholar]
  31. Shimoji K., Higashi H., Kano T. Epidural recording of spinal electrogram in man. Electroencephalogr Clin Neurophysiol. 1971 Mar;30(3):236–239. doi: 10.1016/0013-4694(71)90059-9. [DOI] [PubMed] [Google Scholar]
  32. Stark R. J., Kennard C., Swash M. Hand wasting in spondylotic high cord compression: an electromyographic study. Ann Neurol. 1981 Jan;9(1):58–62. doi: 10.1002/ana.410090111. [DOI] [PubMed] [Google Scholar]
  33. Takahashi M., Sakamoto Y., Miyawaki M., Bussaka H. Increased MR signal intensity secondary to chronic cervical cord compression. Neuroradiology. 1987;29(6):550–556. doi: 10.1007/BF00350439. [DOI] [PubMed] [Google Scholar]
  34. Takahashi M., Yamashita Y., Sakamoto Y., Kojima R. Chronic cervical cord compression: clinical significance of increased signal intensity on MR images. Radiology. 1989 Oct;173(1):219–224. doi: 10.1148/radiology.173.1.2781011. [DOI] [PubMed] [Google Scholar]
  35. Tamaki T., Tsuji H., Inoue S., Kobayashi H. The prevention of iatrogenic spinal cord injury utilizing the evoked spinal cord potential. Int Orthop. 1981;4(4):313–317. doi: 10.1007/BF00266075. [DOI] [PubMed] [Google Scholar]
  36. Tani T., Ushida T., Yamamoto H., Kimura J. Waveform analysis of spinal somatosensory evoked potential: paradoxically enhanced negative peaks immediately caudal to the site of conduction block. Electroencephalogr Clin Neurophysiol. 1998 Jul;108(4):325–330. doi: 10.1016/s0168-5597(98)00020-3. [DOI] [PubMed] [Google Scholar]
  37. Tani T., Ushida T., Yamamoto H., Okuhara Y. Waveform changes due to conduction block and their underlying mechanism in spinal somatosensory evoked potential: a computer simulation. Technical note. J Neurosurg. 1997 Feb;86(2):303–310. doi: 10.3171/jns.1997.86.2.0303. [DOI] [PubMed] [Google Scholar]
  38. Tani T., Ushida T., Yamamoto H. Surgical treatment guided by spinal cord evoked potentials for tetraparesis due to cervical spondylosis. Paraplegia. 1995 Jun;33(6):354–358. doi: 10.1038/sc.1995.79. [DOI] [PubMed] [Google Scholar]
  39. Taylor A. R., Byrnes D. P. Foramen magnum and high cervical cord compression. Brain. 1974 Sep;97(3):473–480. doi: 10.1093/brain/97.1.473. [DOI] [PubMed] [Google Scholar]
  40. Teresi L. M., Lufkin R. B., Reicher M. A., Moffit B. J., Vinuela F. V., Wilson G. M., Bentson J. R., Hanafee W. N. Asymptomatic degenerative disk disease and spondylosis of the cervical spine: MR imaging. Radiology. 1987 Jul;164(1):83–88. doi: 10.1148/radiology.164.1.3588931. [DOI] [PubMed] [Google Scholar]
  41. White A. A., 3rd, Southwick W. O., Deponte R. J., Gainor J. W., Hardy R. Relief of pain by anterior cervical-spine fusion for spondylosis. A report of sixty-five patients. J Bone Joint Surg Am. 1973 Apr;55(3):525–534. [PubMed] [Google Scholar]
  42. Wu W., Thuomas K. A., Hedlund R., Leszniewski W., Vavruch L. Fast spin-echo MR assessment of patients with poor outcome following spinal cervical surgery. Acta Radiol. 1996 Mar;37(2):153–161. doi: 10.1177/02841851960371P132. [DOI] [PubMed] [Google Scholar]
  43. Yiannikas C., Shahani B. T., Young R. R. Short-latency somatosensory-evoked potentials from radial, median, ulnar, and peroneal nerve stimulation in the assessment of cervical spondylosis. Comparison with conventional electromyography. Arch Neurol. 1986 Dec;43(12):1264–1271. doi: 10.1001/archneur.1986.00520120046015. [DOI] [PubMed] [Google Scholar]
  44. Yonenobu K., Fuji T., Ono K., Okada K., Yamamoto T., Harada N. Choice of surgical treatment for multisegmental cervical spondylotic myelopathy. Spine (Phila Pa 1976) 1985 Oct;10(8):710–716. doi: 10.1097/00007632-198510000-00004. [DOI] [PubMed] [Google Scholar]
  45. Yu Y. L., Jones S. J. Somatosensory evoked potentials in cervical spondylosis. Correlation of median, ulnar and posterior tibial nerve responses with clinical and radiological findings. Brain. 1985 Jun;108(Pt 2):273–300. doi: 10.1093/brain/108.2.273. [DOI] [PubMed] [Google Scholar]

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