多种脊髓诱发电位测评高龄脊髓型颈椎病患者颈脊髓机能

目的调查高龄脊髓型颈椎病患者的颈脊髓机能状态,并结合磁共振影像学（MRI）及X线放射学探讨其病理生理形成机制.方法对23例MRI显示为多椎间脊髓压迫的高龄脊髓型颈椎病患者,采用经颅电刺激-脊髓硬膜外记录、经脊髓硬膜外刺激-脊髓硬膜外记录、经正中神经刺激-脊髓硬膜外记录的三种脊髓诱发电位进行颈脊髓机能测定.结果17例患者（73.9%）显示为颈脊髓单一椎间的障碍,其中10例位于C3-4、5例位于C4-5、2例位于C5-6.另外6例患者（26.1%）的正中神经刺激-脊髓硬膜外记录结果表现为多个或两个椎间的障碍.结论在MRI影像学上显示为多椎间脊髓压迫的高龄脊髓型颈椎病患者,其多数在脊髓电生理上：表现为单一颈椎椎间的脊髓白质损伤,特征是不仅脊髓后索的感觉传导束,而且侧索的皮质脊髓束也受到损伤.结合X线放射学结果分析,C3-4或C4-5颈椎椎间的过大活动度或不稳是导致高龄脊髓型颈椎病患者脊髓传导束损伤的一个重要原因.

Functional evaluation using several evoked spinal cord potentials in elderly patients with cervical spondylotic myelopathy

Objective To investigate the function states of cervical spinal cord in elderly patients with cervical spondylotic myelopathy (CSM), and explore its pathophysiologic mechanism using MRI and X-ray radiation. Methods Several evoked spinal cord potentials (ESCPs) following transcranial electric stimulation (TCE-ESCPs), epidural spinal cord stimulation (Spinal-ESCPs) and median nerve stimulation (MN-ESCPs) were recorded intraoperatively before laminoplasty in 23 elderly patients with cervical spondylotic myelopathy whose multiple intervertebral compression of cervical spinal cord was shown on MRI. Results A single intervertebral lesion of cervical spinal cord was revealed in 17 patients (73.9%), 10 patients at the C3-4, 5 patients at the C4-5, and 2 patients at the C5-6 by several ESCPs. Multiple or double intervertebral lesions were shown in 6 patients (26.1%) by MN-ESCPs. However in these 6 patients, TCE-ESCPs and spinal-ESCPs showed a single intervertebral lesion in 5 patients, and normal in 1 patient. Conclusion In most elderly patients with CSM who have multiple intervertebral compressions of cervical spinal cord on MRI, white matter is impaired at the single cervical intervertebral level, and not only the dorsal column pathway, but also the corticospinal tract can be affected. According to the findings of MRI combined with radiography, the excessive motion and instability of the intervertebral levels of C3-4 or C4-5 plays an important role in inducing the long tract lesion in elderly patients with CSM.