Response: Re: Cervical Spondylotic Myelopathy: A Guide to Diagnosis and Management

[摘要] Drs. Fustes and Rodriguez highlight an additional tool that can aid in managing potential cervical spondylotic myelopathy (CSM) cases via their suggestion of the utility of electrophysiological studies as an adjunct in the assessment of CSM. While we agree with Lo that electromyography (EMG) is not required for CSM diagnosis, it certainly may provide utility in some specific scenarios.1 In general, Zileli2 notes that motor evoked potential, spinal cord evoked potential, somatosensory evoked potential, and EMG are all tests that can be used to help narrow the differential diagnosis for CSM. Other more focused uses of EMG include assessing arm pain with suspicion of spinal nerve root compression. EMG can help determine whether nerve compression is the extremity (ie, in cubital tunnel syndrome, carpal tunnel syndrome, or other less common peripheral nerve compression syndromes) versus central as a result of spinal nerve radiculopathy. By locating the site of compression via EMG, potential spinal surgery may be avoided if the pathology was in fact occurring distal to the spine column. In addition, EMG may provide value in better localizing the nerve root compression at a specific level of the cervical spine in patients whose magnetic resonance imaging (MRI) shows multi-level moderate compression. Through more accurate localization, clinicians may potentially limit cervical levels included in surgical intervention. In addition, EMG may also play a role in characterization of the gait abnormalities that are often seen in CSM, which can impact rehabilitation prognosis.

[学科分类] 过敏症与临床免疫学