Publication: Servikal radikülopatilerde F dalgası, H refleksi ve somatosensoriyel uyandırılmış potansiyeller
Abstract
Radikülopatilerin elektrofizyolojik değerleMirilmesinde motor ve duyusal sinir iletimleri ile iğne elektromyografi (EMG) 'si en sık kullanılan tanı yöntemleridir. Sinir iletim çalışmaları periferik sinirin distal bölümündeki fonksiyonunu değerlendirilmesini sağlar. Antidromik uyarı tekniği kullanılarak elde edilen geç yanıtlar ve somatosensoriyel uyandırılmış potansiyel (SUP) gibi inceleme metodlan ise sinirin proksimal bölümündeki fonksiyon bozukluğunu ortaya çıkarabilmektedir. C6 ve C7 kök tutulumu olan servikal radikülopatili 25 hasta ile kontrol grubu olarak 27 sağlıklı birey üzerinden geç yanıtlar ile SUP kayıtlarını alarak bunların kök tutulum tamsındaki yerini araştırıldı. Flexor carpi radialis kasından H refleksi ve F dalgası yanıtları ile, median sinirin SUP yanıtları incelendi. Hastaların patolojik ve sağlam tarafları arasında H refleksi latansı, maksimum H amplitüdü ile maksimum H / maksimum motor amplitüd oram; minimum F yanıtı, maksimum F yanıtı, ortalama F yanıtı, F persistansı, F kronodispersiyonu ortalamaları; SUP incelemesinde N9, Nil, N13, P14, N20 ve P22 dalgalarının latansları ve N9-N11, N9-N13, N9-P14, N9-N20 dalgalarının interpik latansları incelendi. Hastaların iki tarafından elde edilen sonuçlar birbirleriyle ve kontrol grubunun sonuçlan ile karşılaştırıldı. Buna göre, H refleksi latansı patolojik tarafta sağlam tarafa ve kontrol grubuna göre anlamlı olarak uzun bulundu (p<Ö,0001 ve p<0,001). Minimum F ve ortalama F latanslan hasta grubunun iki tarafı karşılaştırıldığında hasta tarafta anlamlı olarak arttığı gözlendi (p<0,01). SUP parametrelerinde ise anlamlı farklılık tespit edilmedi. Sonuç olarak H refleksi latansının gecikmesi ile F minimum ve F ortalama latanslarmda gecikmenin servikal radikülopatide tanıya katkılarının olduğu kanısına varıldı.
Conventional EMG as well as motor and sensorial nerve conduction studies are still parts of the routine in electrophysiological evaluation of the radiculopathies. Studies done using the antidromic stimulation can show the functionality disorders at the proximal site of the nerve. Our study group consisted of patients with unilateral either C6 or C7 root involvement. MRI and the needle EMG showed chronical neurological involvement pattern at all. In the patient group, patients were 8 male and 17 male, total 25. The control group consisted of 27 individuals were 3 male and 24 females. The H reflex and F wave are obtained from the flexor carpi radialis muscle. The SEP responses are obtained by the stimulation of the median nerve at the wrist.. The H reflex latencies, maximum H amplitude and the max. H / max. motor amplitude ratios, minimum F latencies, maximum F latencies, mean F latencies, F persistence, mean F chronodispertions are compared at the pathalogical and the intact sides of the patients. With SEP investigation, N9, Nil, N13, P14, N20 and P22 wave latencies and N9-N11, N9-N13, N9-P14, N9-N20 interpeak wave latencies are compared. The results are compared with the results of the controls. The H reflex latencies are found prolonged at the pathalogical side compared with the intact side and the control cases (p<0.0001 and p<0,001). Fminimum and F mean latancies are found prolonged too(p<0,01). No statistical difference is found at the other H reflex^ F wave and SEP parameters. In conclusion, we could say that prolonged H reflex latencies and F niinimum and F mean latancies are of value in diagnosis of the cervical radiculopathies.
Conventional EMG as well as motor and sensorial nerve conduction studies are still parts of the routine in electrophysiological evaluation of the radiculopathies. Studies done using the antidromic stimulation can show the functionality disorders at the proximal site of the nerve. Our study group consisted of patients with unilateral either C6 or C7 root involvement. MRI and the needle EMG showed chronical neurological involvement pattern at all. In the patient group, patients were 8 male and 17 male, total 25. The control group consisted of 27 individuals were 3 male and 24 females. The H reflex and F wave are obtained from the flexor carpi radialis muscle. The SEP responses are obtained by the stimulation of the median nerve at the wrist.. The H reflex latencies, maximum H amplitude and the max. H / max. motor amplitude ratios, minimum F latencies, maximum F latencies, mean F latencies, F persistence, mean F chronodispertions are compared at the pathalogical and the intact sides of the patients. With SEP investigation, N9, Nil, N13, P14, N20 and P22 wave latencies and N9-N11, N9-N13, N9-P14, N9-N20 interpeak wave latencies are compared. The results are compared with the results of the controls. The H reflex latencies are found prolonged at the pathalogical side compared with the intact side and the control cases (p<0.0001 and p<0,001). Fminimum and F mean latancies are found prolonged too(p<0,01). No statistical difference is found at the other H reflex^ F wave and SEP parameters. In conclusion, we could say that prolonged H reflex latencies and F niinimum and F mean latancies are of value in diagnosis of the cervical radiculopathies.