Traumatic cervical spinal cord injury: Relation between somatosensory evoked potentials, neurological deficit, and hand function

doi:10.1016/S0003-9993(96)90219-1

Archives of Physical Medicine and Rehabilitation

Volume 77, Issue 1, January 1996, Pages 48-53

https://doi.org/10.1016/S0003-9993(96)90219-1 Get rights and content

Abstract

Objective: Median and ulnar somatosensory evoked potentials (SEP) in the assessment of cervical spinal cord injury (SCI) in relation to the outcome of hand function.

Design: Cohort analytical study.

Setting: Spinal cord injury center, university hospital.

Patients: Consecutively sampled, 23 acute and 46 chronic tetraplegics.

Main Outcome Measures: (1) Median and ulnar SEP recordings graded in 5 categories, from normal to absent; (2) clinical examination of algesia/aesthesia in dermatomes C5/6 and C8/Th1 graded in categories of normal, impaired, and loss of sensation; (3) clinical examination of hand function graded in 4 categories, from active to inactive hand function.

Results: Pathological median and ulnar SEP were found in 46% and 76% of patients, respectively. A differentiation between upper (C3–C6) and lower (C6/C7-Th1) cervical SCI was possible by comparing the SEP N20 latencies (but not amplitudes) of both nerves (Mann-Whitney U test, p < .01). In follow-up examinations over 6 months the N20 amplitude increased significantly (ANCOVA, p < .001), while the N20 latency did not change. By both ulnar SEP recordings and assessment of the sensory deficit in dermatome C8/Th1 the outcome of hand function, ie, the development of active or inactive hand function, could be predicted (Mann-Whitney U test, p < .01).

Conclusion: Median and ulnar SEP are valuable to indicate the level of injury, the degree of sensory impairment and to predict the outcome of hand function even in unconscious patients. They can improve the diagnostic assessment of cervical SCI.

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Citation Excerpt :
Due to the lack of more direct methods to investigate neural pathways underlying certain behaviors (i.e., implantable electrodes, fiber tracking, optogenetics, genetically modified animals), alternative assessments need to be employed in humans. Noninvasive or minimally invasive electrophysiological recordings can elucidate the integrity and connectivity of central and peripheral sensory and motor pathways in SCI patients either during a resting state (i.e., while subjects are lying; Chabot et al., 1985; Curt and Dietz, 1996, 1997; Curt et al., 1998; Kirshblum et al., 2001; Kovindha and Mahachai, 1992) or during activities such as locomotion (Barthelemy et al., 2010; Capaday et al., 1999; Dietz et al., 1998, 2002, 2009; Fung and Barbeau, 1994; Harkema et al., 1997; Schubert et al., 1997). Interestingly, SCI patients may improve their ambulatory capacity in the absence of concomitant improvements of corticospinal conduction velocity assessed via the latencies of motor- and somatosensory-evoked potentials (MEPs and SSEPs) (Curt et al., 2008).
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^☆: Supported by the Swiss National Science Foundation (grant 31-33567.92) and the International Research Institute for Paraplegia (P16/93).

^☆☆: No commercial party having a direct or indirect interest in the results of the research supporting this article has conferred or will confer a benefit upon the authors or upon any organization with which the authors are associated.

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ArticleTraumatic cervical spinal cord injury: Relation between somatosensory evoked potentials, neurological deficit, and hand function☆,☆☆

Abstract

Arch Phys Med Rehabil

Electroencephalogr Clin Neurophysiol

Short-latency somatosensory-evoked potentials from radial, median, ulnar, and peroneal nerve stimulation in the assessment of cervical spondylosis

Arch Neurol

Segmental dysfunction of the cervical cord revealed by abnormalities of the spina N13 potential in cervical spondylotic myelopathy

Neurology

N24 Spinal response to tibial erve stimulation and magnetic resonance imaging in lesions of the lumbosacral spinal cord

Neurology

Spinale und subkortikale somatosensibel evozierte Potentiale: Vergleich mit der Lokalisation spinaler, medullarer und potiner Laesionen und im Hirntod

EEG EMG Z

Dermatomal somatosensory evoked potentials (DSSEPs) in patients with cervical lesions and brachial plexus injuries in comparison with somatosensory evoked potentials (SSEPs)

Somatosensory evoked potentials after multisegmental upper limb stimulation in diagnosis of cervical spondylotic myelopathy

J Neurol Neurosurg Psychiatry

Correlation of SEPO abnormalities with brain and cervical cord MRI in multiple sclerosis

Brain

Experimental and clinical use of somatosensory evoked potentials in surgery of aneurysms of the descending thoracic aorta

Thorac Cardiovasc Surg

Neurological improvement in traumatic injuries of cervical spinal cord

Paraplegia

Correlation of somatosensory evoked potentials and neurological findings in spinal cord injury

Motor recovery of the upper extremities in traumatic quadriplegia: A multicenter study

Arch Phys Med Rehabil

Article
Traumatic cervical spinal cord injury: Relation between somatosensory evoked potentials, neurological deficit, and hand function☆,☆☆