title: Systematic correlation of transcranial magnetic stimulation and magnetic resonance imaging in cervical spondylotic myelopathy.
abstract: METHODS
  A prospective study over a 3.5-year period involving transcranial magnetic stimulation and magnetic resonance imaging.
  
  
  OBJECTIVE
  To assess the correlation of transcranial magnetic stimulation and magnetic resonance imaging in cervical spondylotic myelopathy qualitatively and statistically.
  
  
  BACKGROUND
  Cervical spondylotic myelopathy presents with different degrees of cord compression, which can be assessed by magnetic resonance imaging. There are no large studies correlating transcranial magnetic stimulation and magnetic resonance imaging findings in this condition.
  
  
  METHODS
  A total of 141 patients with a clinical diagnosis of cervical spondylotic myelopathy were prospectively studied over a 3.5-year period. They were classified into Groups 1 to 4 based on severity of cervical cord changes on magnetic resonance imaging. All had transcranial magnetic stimulation and central motor conduction time measurements within 2 months of the magnetic resonance imaging study.
  
  
  RESULTS
  Twenty-eight, 49, 28, and 36 patients were classified into Groups 1 to 4, respectively. Mean upper limb and lower limb central motor conduction times correlated with the severity of magnetic resonance cord compression. The absence of central motor conduction time abnormalities correlated reliably with the absence of cervical cord impingement as in Group 1. Statistically significant right left difference in central motor conduction time in the lower limbs was seen between Groups 1 (no cord changes) and Group 2 (mild cord impingement). Eight other patients with diagnoses other than cervical spondylotic myelopathy all showed central motor conduction time abnormalities. The sensitivity and specificity for transcranial magnetic stimulation for differentiating the presence from absence of magnetic resonance imaging cord abnormality were 100% and 84.8%, respectively.
  
  
  CONCLUSIONS
  Transcranial magnetic stimulation showed excellent correlation with magnetic resonance imaging findings and can be considered as an effective technique for screening patients for cervical cord abnormalities before magnetic resonance imaging in the clinical setting. The findings in this study have relevant implications in the pathophysiology, management, and health costs of cervical spondylotic myelopathy.
authors.affiliation: Department of Neurology, Singapore General Hospital, Singapore. gnrlyl@sgh.com.sg
authors.forename: Y L
authors.initials: YL
authors.lastname: Lo
authors.forename: L L
authors.initials: LL
authors.lastname: Chan
authors.forename: W
authors.initials: W
authors.lastname: Lim
authors.forename: S B
authors.initials: SB
authors.lastname: Tan
authors.forename: C T
authors.initials: CT
authors.lastname: Tan
authors.forename: J L T
authors.initials: JL
authors.lastname: Chen
authors.forename: S
authors.initials: S
authors.lastname: Fook-Chong
authors.forename: P
authors.initials: P
authors.lastname: Ratnagopal
mesh_terms: D000328:Adult; D000368:Aged; D002574:Cervical Vertebrae; D004576:Electromyography; D005073:Evoked Potentials, Somatosensory; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009431:Neural Conduction; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D013117:Spinal Cord Compression / Q000175:diagnosis* / Q000209:etiology / Q000473:pathology / Q000503:physiopathology; D013128:Spinal Osteophytosis / Q000150:complications* / Q000473:pathology; D050781:Transcranial Magnetic Stimulation