title: The role of motor-evoked potentials in the management of cervical spondylotic myelopathy.
abstract: BACKGROUND
  Cervical spondylotic myelopathy (CSM) is a common disorder, but its management and the role of surgery are still a matter of controversy. The assessment of surgical outcome is complicated by the lack of reliable and objective methods to assess the severity of the myelopathy and its evolution. Motor-evoked potentials (MEPs) are a useful and reliable tool to measure noninvasively the involvement of the corticospinal tract in patients with CSM. Recent evidence suggests that MEPs could also have a role in monitoring the effect of surgical therapy.
  
  
  OBJECTIVE
  The aim of the present study is to use MEPs for the functional assessment of spinal cord before and after surgery and to correlate changes in MEPs with clinical findings.
  
  
  METHODS
  This is a retrospective cohort study.
  
  
  METHODS
  Thirty-eight patients affected by CSM who underwent surgical intervention.
  
  
  METHODS
  We used the 18-point modified Japanese Orthopedic Association (mJOA) score for clinical evaluation and the central motor conduction time (CMCT) for the study of MEPs.
  
  
  METHODS
  All patients were evaluated both clinically and neurophysiologically before (7-15 days) and after (6-12 months) surgery. MEPs were recorded from the biceps, abductor digiti minimi, and tibialis anterior muscles bilaterally.
  
  
  RESULTS
  After surgery, the 18-point mJOA score increased significantly from 10.1 to 15.1, and the value of CMCT for tibialis anterior muscles showed a slight but significant reduction, more evident in patients with mild to moderate symptoms.
  
  
  CONCLUSIONS
  Early surgical intervention for CSM could produce a beneficial effect on spinal cord functionality that can be detected by MEPs.
authors.affiliation: Institute of Neurology, Campus BioMedico University, Via Alvaro del Portillo 200, 00128 Rome, Italy; Fondazione Alberto Sordi - Research Institute for Ageing, Via Álvaro del Portillo 5, 00128 Rome, Italy. Electronic address: fiorecapone@virgilio.it.
authors.forename: Fioravante
authors.initials: F
authors.lastname: Capone
authors.forename: Francesco Ciro
authors.initials: FC
authors.lastname: Tamburelli
authors.forename: Fabio
authors.initials: F
authors.lastname: Pilato
authors.forename: Paolo
authors.initials: P
authors.lastname: Profice
authors.forename: Federico
authors.initials: F
authors.lastname: Ranieri
authors.forename: Riccardo
authors.initials: R
authors.lastname: Di Iorio
authors.forename: Francesco
authors.initials: F
authors.lastname: Iodice
authors.forename: Gabriella
authors.initials: G
authors.lastname: Musumeci
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Di Lazzaro
mesh_terms: D002574:Cervical Vertebrae; D015331:Cohort Studies; D019299:Decompression, Surgical; D019054:Evoked Potentials, Motor / Q000502:physiology*; D006801:Humans; D011712:Pyramidal Tracts / Q000503:physiopathology*; D012189:Retrospective Studies; D013118:Spinal Cord Diseases / Q000175:diagnosis* / Q000503:physiopathology / Q000601:surgery; D055009:Spondylosis / Q000150:complications / Q000503:physiopathology* / Q000601:surgery; D016896:Treatment Outcome
keywords: Cervical spondylotic myelopathy; Motor-evoked potentials; Spinal cord; Surgery; Transcranial magnetic stimulation