Contact heat evoked potentials reveal distinct patterns of spinal cord impairment in degenerative cervical myelopathy beyond MRI lesions

Eur J Neurol, 2025 · DOI: 10.1111/ene.70001 · Published: January 1, 2025

Simple Explanation

Magnetic resonance imaging (MRI) may suggest spinal cord compression and structural lesions in degenerative cervical myelopathy (DCM) but cannot reveal functional impairments in spinal pathways. Contact heat evoked potentials (CHEPs) may provide a promising tool to improve the early diagnosis of DCM. This study underscores the significance of employing advanced neurophysiological assessments in conjunction with advanced MRI in a cohort of predominantly mild DCM.

Study Duration

October 2016 and December 2022

Participants

138 individuals with degenerative cervical myelopathy

Evidence Level

Not specified

Key Findings

1
Abnormal CHEPs were present in T2-positive DCM (C6:41%; C8:32%; T4:24%) and T2-negative DCM (C6:35%; C8:54%; T4:26%).
2
Multisegmental CHEP abnormalities at C6 and C8 were related to increased spinal cord motion (p = 0.030; ϵ2 = 0.072), and reduced upper extremity pinprick (p = 0.046; ϵ2 = 0.063) and motor scores (p = 0.005; ϵ2 = 0.108).
3
Individuals with multisegmental CHEP abnormalities showed higher degrees of spinal cord motion compared to those with normal CHEPs, suggesting increased mechanical stress.

Research Summary

CHEPs revealed distinct patterns of spinal cord impairment independent of structural T2-positive lesions, which were associated with measures of cord motion. CHEPs thus provide valuable complementary diagnostic insights into spinal cord integrity beyond MRI. This is especially important in incipient myelopathy to inform early diagnosis and timely interventions before the development of definite cord lesions.

Practical Implications

Diagnostic Tool

CHEPs offer a valuable method for identifying functional impairments in DCM, even in the absence of MRI-detectable lesions.

Personalized Medicine

The identification of specific neurophysiological patterns can aid in tailoring treatment strategies to individual patients.

Early Intervention

Early detection of spinal cord impairment through CHEPs can facilitate timely interventions to prevent disease progression.

Study Limitations

1
CHEPs could not be acquired at all dermatomes in all individuals.
2
The clinical diagnosis of DCM often occurs at rather late stages of disease progression
3
Study population was mildly affected

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