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The search strategy described above yielded 62 results. The two reviewers independently assessed the methodological quality of each study and risk of bias, focusing on blinding and other potential sources of bias. In case of missing or incomplete data, principal investigators of included trials were contacted and additional information requested. Full-text articles in English language were retrieved for the selected titles, and reference lists of the retrieved articles were searched for additional publications. Any disagreement was resolved through consensus. Two review authors (FB and PL) screened the titles and abstracts of the initially identified studies to determine whether they satisfied the selection criteria. The MEDLINE, accessed by Pubmed (1966–April 2015) and EMBASE (1980–April 2015) electronic databases, was searched using the medical subject headings (MeSH): ‘compressive myelopathy’, ‘cervical spondylotic myelopathy’, ‘cervical spondylogenic myelopathy’, ‘motor-evoked potentials’, ‘transcranial magnetic stimulation’, ‘somatosensory-evoked potentials’, ‘electromyograpy’, ‘nerve conduction studies’ and ‘cutaneous silent period’.
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We aimed in this review article to summarize the published articles dealing with electrophysiological studies in CSM patients, in order to assess their indication and usefulness. 5 Therefore, for the correct interpretation of the neuroimaging findings, the functional assessment of the long central pathways, as well as of motor and sensory neurones in the cervical gray matter, is helpful or even mandatory in patients with CSM. Magnetic resonance imaging (MRI) of the spinal cord can show signal abnormalities at the level of cord compression but gives no precise information on cervical cord dysfunction in CSM, as radiological data are discordant with clinical status in 50% of cases.
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3 However, sensory–motor deficits and reflex changes in the upper limbs can be missing 4 in these cases, CSM can be confused with other degenerative diseases such as amyotrophic lateral sclerosis (ALS). 2 The diagnosis of CSM is essentially based on the combination of clinical signs/symptoms suggesting involvement of spinal long tracts (spastic paraparesis associated with a variable degree of lower limb ataxia) and clinical signs/symptoms indicating dysfunction of motor and sensory neurons in the cervical gray matter. The clinical sequelae of cervical spondylotic myelopathy (CSM) are a broad spectrum of motor and sensory abnormalities related to dysfunction of the cervical spinal cord. Similar content being viewed by othersĬervical spondylosis (CS) is the most common cause of cervical myelopathy. The studies reported in this review highlight the crucial role of the electrophysiological studies in diagnosis and management of CSM. Neuroimaging, especially magnetic resonance imaging, represents the procedure of choice for the diagnosis of CSM, but a correct interpretation of morphological findings can be achieved only if they are correlated with functional data. CSP also shows a high sensitivity for detecting CSM. EMG and NCS improve the sensitivity of cervical radiculopathy detection and may help rule out peripheral nerve problems that can cause symptoms that are similar to those of CSM. SEPs and MEPs are also useful in follow-up evaluation of sensory and motor function during surgical treatment and rehabilitation. MEPs may also help in the differential diagnosis between spinal cord compression and neurodegenerative disorders. Segmental cervical cord dysfunction can be revealed by an abnormal spinal N13 response, whereas the P14 potential is a reliable marker of dorsal column impairment. SEPs and MEPs recording can usefully supplement clinical examination and neuroimaging findings in assessing the spinal cord injury level and severity. The MEDLINE, accessed by Pubmed and EMBASE electronic databases, was searched using the medical subject headings: ‘compressive myelopathy’, ‘cervical spondylotic myelopathy (CSM)’, ‘cervical spondylogenic myelopathy’, ‘motor evoked potentials (MEPs)’, ‘transcranial magnetic stimulation’, ‘somatosensory evoked potentials (SEPs)’, ‘electromyography (EMG)’, ‘nerve conduction studies (NCS)’ and ‘cutaneous silent period (CSP)’. The objective of this review article was to assess indications and usefulness of various neurophysiological techniques in diagnosis and management of cervical spondylogenic myelopathy (CSM).