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Clinical Neurophysiology of the Cervical Spine: Indication for Surgery

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Cervical Spine

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Abstract

A proper diagnosis is the fundamental prerequisite for a suitable indication for cervical spine surgery. Cervical spondylotic myelopathy (CSM) and radiculopathy (CSR) are the most common spinal cord injuries. Their diagnosis is hard due to the complexity of their symptoms and the numerous pathologies that can simulate a cervical spine disease. An adequate diagnostic process can drastically reduce the misdiagnosis and legal disputes. Such approach includes a thorough clinical examination followed by instrumental examinations. The correct diagnosis is only determined by the concordance between the clinical pictures and the instrumental findings.

Imaging studies are the first choice investigations in cervical spine injury, particularly the MRI, which has revolutionized diagnostics by allowing a detailed spinal morphology examination. However, MRI cannot provide any information on the functional state of the spinal structures, which is vitally important in the diagnostic process. This limit can be overcome due to the neurophysiological tests, able to provide the functional assessments necessary for diagnosis. The combined use of neuroimaging and clinical neurophysiology guarantees a complete morphological and functional assessment.

Electromyography (EMG) and nerve conduction study (NCS) for the functional study of the cervical roots, Somatosensory Evoked Potentials (SEP) and Motor Evoked Potentials (MEP), respectively, for the study of the sensory and motor neural pathways of the spinal cord, are the neurophysiological studies used in cervical spine diagnostics.

Unlike cervical radiculopathy, the myelopathy always requires surgery due to the irreversibility of the spinal damage and, therefore, its early detection is essential to limit permanent deficits. Neurophysiological examinations can play an important role in the diagnosis of myelopathy also due to their ability to identify subclinical spinal damage.

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Authors and Affiliations

  1. Neurology Department, Rome American Hospital, Rome, Italy

    Rodolfo Quadrini & Chiara Lepre

  2. Internal Physician at Casa di Cura Villa Sandra, Rome, Italy

    Antonio Luzzo

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  1. Rodolfo Quadrini
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  2. Chiara Lepre
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  3. Antonio Luzzo
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Editors and Affiliations

  1. Spine Center, Rome American Hospital, Rome, Italy

    Pier Paolo Maria Menchetti

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Quadrini, R., Lepre, C., Luzzo, A. (2022). Clinical Neurophysiology of the Cervical Spine: Indication for Surgery. In: Menchetti, P.P.M. (eds) Cervical Spine. Springer, Cham. https://doi.org/10.1007/978-3-030-94829-0_5

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  • DOI: https://doi.org/10.1007/978-3-030-94829-0_5

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  • Online ISBN: 978-3-030-94829-0

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