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Assessing hand dysfunction in cervical spondylotic myelopathy.

Zachary A Smith1, Alexander J Barry2, Monica Paliwal1

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Cervical spondylotic myelopathy (CSM) patients exhibit hyperreflexia and poor proprioception, leading to hand dysfunction. Objective testing reveals these deficits and their improvement post-surgery, aiding treatment evaluation.

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Area of Science:

  • Neurology
  • Biomedical Engineering
  • Orthopedics

Background:

  • Cervical spondylotic myelopathy (CSM) is a progressive neurological condition affecting the spinal cord.
  • Hand dysfunction is a common and debilitating symptom in CSM patients.
  • Current assessment methods for hand dysfunction in CSM may lack objectivity.

Purpose of the Study:

  • To quantitatively assess hand dysfunction in CSM patients using a novel apparatus.
  • To investigate the relationship between MRI findings and objective measures of hand function.
  • To evaluate the potential of the apparatus for tracking treatment efficacy.

Main Methods:

  • Twenty CSM patients and 17 controls underwent clinical scoring (mJOA, Nurick) and MRI assessment.
  • A custom motorized apparatus measured reflexes (hyperreflexia), proprioception, and grip strength.
  • Surface electromyography (EMG) recorded muscle activation during reflex testing.

Main Results:

  • CSM patients showed significantly higher reflexes and worse proprioception compared to controls.
  • MRI compression ratio (CR < 0.44) predicted increased reflex activity.
  • Six months post-surgery, patients demonstrated significant improvements in reflexes and proprioception.

Conclusions:

  • Hyperreflexia and impaired proprioception are key contributors to hand disability in CSM.
  • Objective, apparatus-based testing can quantify CSM-related hand dysfunction.
  • This method shows promise for evaluating treatment effectiveness and guiding future research.