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Electrophysiological Changes in the Peripheral Nervous System After Subacute Spinal Cord Injury

Published:February 05, 2020DOI:https://doi.org/10.1016/j.apmr.2019.12.019

      Abstract

      Objective

      To assess factors affecting electrophysiological changes in the peripheral nervous system below the neurologic level of injury (NLI) in patients with subacute spinal cord injury (SCI).

      Design

      Retrospective observational study.

      Setting

      An inpatient rehabilitation center of a university hospital.

      Participants

      Through reviewing the medical records of 151 subjects with SCI, 42 without any other disease inducing peripheral neurologic abnormalities were included. They were classified into 2 groups, with or without denervation potentials in electromyography (EMG) below NLI.

      Intervention

      Not applicable.

      Main Outcome Measures

      Demographics and clinical characteristics including NLI, American Spinal Injury Association Impairment Scale (AIS), and Lower Extremity Motor Score were compared. Results of electrophysiological study including nerve conduction study, somatosensory-evoked potential (SSEP), and motor-evoked potential (MEP) were compared.

      Results

      Denervation potentials in EMG below NLI were observed in 20 subjects, and 10 of them were AIS A or B, but there was none in subjects without denervation potentials (P<.001). The lower extremity motor score was 4.35±7.74 in the group with denervation potentials, lower than 33.64±13.60 of the opposite group (P<.001). In the analysis of electrophysiological study, patients with denervation potentials showed a higher proportion of no response than patients without denervation potentials (60.0% vs 11.4% in peroneal nerve conduction study, 35.0% vs 2.3% in tibial nerve conduction study, 80.0% vs 18.2% in SSEP, 87.5% vs 22.7% in MEP; P<.001, respectively). Additionally, greater axonal loss, based on decrease of amplitude without delayed latency on nerve conduction study, was observed in the group with denervation potentials than the opposite group (P<.001).

      Conclusion

      Among subjects with subacute SCI, cases of peripheral nervous dysfunction below the injury site occur, possibly associated with the severity of SCI.

      Keyword

      List of abbreviations:

      AIS (American Spinal Injury Association Impairment Scale), CMAP (compound muscle action potential), EMG (electromyography), MEP (motor-evoked potential), NLI (neurologic level of injury), SA (spontaneous activity), SCI (spinal cord injury), SNAP (sensory nerve action potential), SSEP (somatosensory-evoked potential)
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