Epidemiological study of cervical cord compression and its clinical symptoms in community-dwelling residents.

BACKGROUND: Degenerative compressive myelopathy (DCM) is caused by cervical cord compression. The relationship between the magnitude and clinical findings of cervical cord compression has been described in the literature, but the details remain unclear. This study aimed to clarify the relationship between the magnitude and clinical symptoms of cervical cord compression in community-dwelling residents. METHODS: The present study included 532 subjects. The subjective symptoms and the objective findings of one board-certified spine surgeon were assessed. The subjective symptoms were upper extremity pain and numbness, clumsy hand, fall in the past 1 year, and subjective gait disturbance. The objective findings were: Hoffmann, Trömner, and Wartenberg signs; Babinski's and Chaddock's signs; hyperreflexia of the patellar tendon and Achilles tendon reflexes; ankle clonus; Romberg and modified Romberg tests; grip and release test; finger escape sign; and grip strength. Using midsagittal T2-weighted magnetic resonance imaging, the anterior-posterior (AP) diameters (mm) of the spinal cord at the C2 midvertebral body level (DC2) and at each intervertebral disc level from C2/3 to C7/T1 (DC2/3-C7/T1) were measured. The spinal cord compression ratio (R) for each intervertebral disc level was defined and calculated as DC2/3-C7/T1 divided by DC2. The lowest R (LR) along C2/3 to C7/T1 of each individual was divided into 3 grades by the tertile method. The relationship between LR and clinical symptoms was investigated by trend analysis. RESULTS: The prevalence of subjective gait disturbance increased significantly with the severity of spinal cord compression (p = 0.002812), whereas the other clinical symptoms were not significantly related with the severity of spinal cord compression. CONCLUSIONS: The magnitude of cervical cord compression had no relationship with any of the neurologic findings. However, subjective gait disturbance might be a better indicator of the possibility of early stage cervical cord compression.

The Wnt/ß-Catenin Pathway Regulated Cytokines for Pathological Neuropathic Pain in Chronic Compression of Dorsal Root Ganglion Model.

Neuropathic pain is one of the important challenges in the clinic. Although a lot of research has been done on neuropathic pain (NP), the molecular mechanism is still elusive. We aimed to investigate whether the Wnt/ß-catenin pathway was involved in NP caused by sustaining dorsal root ganglion (DRG) compression with the chronic compression of dorsal root ganglion model (CCD). Our RNA sequencing results showed that several genes related to the Wnt pathway have changed in DRG and spinal cord dorsal horn (SCDH) after CCD surgery. Therefore, we detected the activation of the Wnt/ß-catenin pathway in DRG and SCDH and found active ß-catenin significantly upregulated in DRG and SCDH 1 day after CCD surgery and peaked on days 7-14. Immunofluorescence results also confirmed nuclear translocalization of active ß-catenin in DRG and SCDH. Additionally, rats had obvious mechanical induced pain after CCD surgery and the pain was significantly alleviated after the application of the Wnt/ß-catenin pathway inhibitor XAV939. Furthermore, we found that the levels of proinflammatory factors tumor necrosis factor-α (TNF-α) and interleukin-18 (IL-18) were significantly elevated in CCD rat serum, while the levels of them were correspondingly decreased after the Wnt/ß-catenin pathway being inhibited. The results of Spearman correlation coefficient analysis showed that the levels of TNF-α and IL-18 were negatively correlated with the mechanical withdrawal thresholds (MWT) after CCD surgery. Collectively, our findings suggest that the Wnt/ß-catenin pathway plays a critical role in the pathogenesis of NP and may be an effective target for the treatment of NP.

Effects of the combination therapy of electric field stimulation and polyethylene glycol in the ex vivo spinal cord of female rats after compression.

The application of electric field stimulation (EFS) can reduce the cation influx after spinal cord injury. However, regenerated cation influx and reestablished injury potential are observed after EFS. Polyethylene glycol (PEG) is popular as an effective cell membrane fusion agent. This study aims to determine the effects of the combination therapy of EFS and PEG in the ex vivo spinal cord after compression. The ex vivo spinal cords of female rats with compression injury were incubated in a double sucrose gap recording chamber (DSGRC) and randomly divided into the following four groups: (1) compression group: compression only, (2) EFS group: EFS for 15 min, (3) PEG group: PEG treatment for 4 min, and (4) EFS + PEG group: EFS for 15 min and PEG treatment for 4 min. The hematoxylin-eosin staining was performed to measure the necrotic area of the spinal cords. The gap potential was detected, and the area under the curve of the gap potential was calculated. The intracellular cation concentration, membrane permeability, and compound action potential were measured and quantified. Results revealed no significant difference in the necrotic areas among different groups, and the compression model of the ex vivo spinal cord in the DSGRC had high consistency and stability. The combination therapy could attenuate cation inflow, promote cell membrane restoration, and promote the functional recovery of the spinal cord conduction after compression in ex vivo spinal cords.

Detection of cerebral reorganization associated with degenerative cervical myelopathy using diffusion spectral imaging (DSI).

Degenerative Cervical Myelopathy (DCM) is a spinal cord disorder that causes significant physical disabilities in older patients. While most DCM research focuses on the spinal cord, widespread reorganization of the brain may occur to compensate for functional impairment. This observational study used diffusion spectrum imaging (DSI) to examine reorganization of cerebral white matter associated with neurological impairment as measured by the modified Japanese Orthopedic Association (mJOA), and severity of neck disability as measured by the Neck Disability Index (NDI) score. A total of 47 patients were included in the cervical spondylosis (CS) cohort: 38 patients with DCM (mean mJOA = 14.6, and mean NDI = 12.0), and 9 neurologically asymptomatic patients with spinal cord compression (mJOA = 18, and mean NDI = 7.0). 28 healthy volunteers (HCs) served as the control group. Lower generalized fractional anisotropy (GFA) was observed throughout much of the brain in patients compared to HCs (p < 0.05). Fiber pathways associated with somatosensory functions, such as the corpus callosum and corona radiata, showed increased quantitative anisotropy (QA) in patients compared to HCs. Correlation analyses further suggested that structural connectivity was enhanced to compensate for neurological dysfunction within sensorimotor regions, where fibers such as the posterior corona radiata had NQA values that were negatively associated with mJOA (p = 0.0020, R2 = 0.2935) and positively associated with NDI score (p = 0.0164, R2 = 0.1889). Altogether, these results suggest that DCM and neurologically asymptomatic spinal cord compression patients tend to have long-term reorganization within the brain, particularly in those regions responsible for the perception and integration of sensory information, motor regulation, and pain modulation.

Solitary thoracic osteochondroma causing spinal compression: Case report.

Spinal osteochondromas are very rare, and they present with nonspecific localized pain owing to bone involvement. Diagnosis is made based on direct X-ray and computed tomography (CT) imaging of the exophytic bone lesion with pedunculated or sessile structure. Although asymptomatic patients can be observed, surgical excision is the main treatment modality. We present the case of a 34-year-old man with solitary thoracic osteochondroma. The patient presented with complaints of pain in the legs, numbness, and inability to walk. The diagnosis was confirmed with CT imaging showing calcified heterogeneous bone lesion originating from the left side of T1-2 facet joint. After total excision, histopathological examination revealed the diagnosis of osteochondroma. No new clinical or radiological findings were detected in the 10-month follow-up.

Feasibility of salvage decompressive surgery for pending paralysis due to metastatic spinal cord compression.

OBJECTIVE: Metastatic spinal cord compression (MSCC) is a frequent phenomenon in cancer disease, often leading to severe neurological deficits. Especially in patients with complete motor paralysis, regaining the ability to walk is an important treatment goal. Our study, therefore, aimed to assess the neurological outcome of patients with MSCC and complete motor paralysis after decompressive surgery. METHODS: Patients with MSCC and complete motor paralysis, surgically treated by decompressive surgery between 2004-2014 at a single institution were retrospectively analyzed. Clinical patient data were collected from medical records. To assess the neurological outcome, Frankel grade (FG) at admission and discharge were compared. Statistical analysis was performed to identify factors associated with an ambulatory status after surgery. RESULTS: Twenty-eight patients were included in this study. The majority of metastases (57 %) were located in the thoracic spine and 75 % showed extraspinal tumor spread. The median interval between loss of ambulation and surgery was 35 h (IQR: 29-70). Posterior circumferential decompression without stabilization was performed in all cases within 24 h of admission. Neurological function improved in 17 patients (63 %) and seven (26 %) even regained the ability to walk following surgery. The rate of complications was low (7%). In statistical analysis, only the Karnofsky Performance Index (KPI) displayed a significant predictive value for an ambulatory status at discharge. CONCLUSIONS: Our findings indicate that severely affected MSCC patients with complete motor paralysis might benefit from decompressive surgery even when the loss of ambulation occurred more than 24 h ago.

Clinical application of Myelopathy-hand Functional Evaluation System in evaluating the postoperative hand motor function for myelopathy patients.

OBJECTIVE: Recovery of hand motor function after surgical treatment in myelopathy patients is commonly observed. Accurate evaluation of postoperative hand function contributes to assessing the efficacy of surgical treatment. However, no objective and effective evaluation method has been widely accepted in clinical practice. Therefore, the study aimed to explore the value of Myelopathy-hand Functional Evaluation System (MFES) in assessing the postoperative hand function for myelopathy patients. MATERIAL AND METHOD: MFES mainly consist of a pair of wise-gloves and a computer with software. One hundred and thirty myelopathy patients were included and all of them received optimal surgery treatment. The Japanese Orthopaedic Association (JOA) scores were marked at preoperative and at 6 months after surgery. All patients were asked to perform the 10-s grip and release test, and the hand movements were simulated and converted into waveforms by MFES. The waveform parameters were measured and analyzed. RESULTS: The JOA scores and the number of grip-and-release (G-R) cycles significantly increased after surgery. Correspondingly, the waveforms of ulnar three fingers were significantly higher and narrower, along with the significantly declined average time per cycle in postoperative. The a/b ratio (Wave height/wave width) of five fingers were significantly higher in postoperative than that in preoperative. Based on the improvement rate of a/b, the excellent and good rate of surgical outcomes was 62.30 %, which was significantly higher than that (47.69 %) based on the improvement rate of JOA scores (P = 0.019). CONCLUSION: MFES is an effective assessment tool in evaluating the postoperative hand function for myelopathy patients.

Multilevel Hemilaminotomy Windows for the Surgical Management of Spinal Epidural Lipomatosis Causing Syringomyelia: Technical Note and Literature Review.

BACKGROUND: Spinal epidural lipomatosis (SEL) is the excessive accumulation of extradural adipose tissue. Severe cases could result in myelopathy, and very rarely, in syringomyelia formation. Surgery has been associated with high morbidity and mortality, and no proven long-term benefits. The objective was to provide a technical description of an efficient and cost-effective procedure for multilevel thoracic decompression without requiring spinal instrumentation. METHODS: A technique of multilevel hemilaminotomy windows is described in a patient with severe thoracic SEL causing syringomyelia. A 3-dimensional spine model was created to illustrate the technique and working angles. We performed a literature review by searching PubMed, Ovid Embase, and Scopus electronic databases with the predetermined inclusion criteria of cases with spinal lipomatosis and a fluid cavity within the spinal cord. RESULTS: The patient's deficit and syringomyelia resolved postoperatively. A review of the literature revealed only 3 cases of syringomyelia secondary to SEL. Syringomyelia expansion occurred in all cases leading to progressive neurologic decline, and surgery with removal of the excessive adipose tissue resolved the syringomyelia and improved the neurologic functioning in all cases. CONCLUSIONS: This technique of multilevel alternating hemilaminotomy "windows" allows for safe and effective decompression and resection of the excessive adipose tissue with reduced operative time and without requiring spine instrumentation. The technique maintains the integrity of the posterior column, thus reducing the risk of postdecompression deformity. Careful bipolar electrocoagulation of internal vertebral veins and meticulous hemostasis is key for minimizing the intraoperative blood loss and avoiding postoperative hematoma formation.

Cervical disc arthroplasty versus anterior cervical discectomy and fusion for the treatment of single-level disc degenerative disease with preoperative reversible kyphosis.

OBJECTIVE: Whether and when cervical disc arthroplasty (CDA) could be indicated for preoperative cervical spine kyphosis is unclear. The purpose of the study was to compare the clinical and radiological outcomes of single-level CDA and single-level anterior cervical discectomy and fusion (ACDF) in the patient with preoperative reversible kyphosis. PATIENTS AND METHODS: From 2014-2018, patients who underwent single-level CDA and single-level ACDF were consecutively reviewed. The Japanese Orthopedic Association score, Neck Disability Index and VAS were used to evaluate clinical outcomes. Range of motion (ROM), C2-7 Cobb angle, functional spinal unit (FSU) angle, and heterotopic ossification (HO) were assessed. RESULTS: Thirty-eight CDA patients (a mean follow-up of 39.8 months) and 42 ACDF patients (37.6 months) with preoperative reversible kyphosis were included. Both groups had significant improvements in clinical outcomes, without statistically significant differences. Before surgery, there was no significant difference in cervical alignment and ROM between groups. After surgery, both groups had a significant increase in C2-7 angle and FSU without significant inter-group differences. At the last follow-up, CDA group consisted of 5 cases of lordosis, 11 cases of kyphosis and 22 cases of straight spine, while the corresponding case number in ACDF group was 4, 12 and 26 (P = 0.866). The C2-7 ROM was preserved in both groups. The segmental ROM of CDA group decreased mildly from 8.3° preoperatively to 5.1° finally, whereas the segmental ROM of ACDF group decreased significantly to nearly zero. 60.5 % (23/38) patients in CDA group developed HO with 9 levels of grade Ⅲ and 3 levels of grade Ⅳ. CONCLUSION: For the patients with single-level disc degenerative disease and preoperative reversible kyphosis, both CDA and ACDF achieved satisfactory and comparable clinical results. CDA was non-inferior to ACDF regarding the radiological outcomes of cervical alignment. Patients in CDA group had a relatively high incidence of HO formation.

Craniocervical junction issues after infancy in achondroplasia.

More information is available concerning risks of craniocervical junction issues in infancy than at later ages. Therefore, we elected to quantify the risks at greater than 1 year of age through a retrospective analysis of 477 individuals with achondroplasia using a REDCap database. Evaluation of these 477 individuals revealed 77 (16.1%) who had pathologic neurologic manifestations after 1 year of age related to the craniocervical junction. Within this subpopulation of 77 individuals, 43 (55.8%) underwent craniocervical decompression surgery, or 9.0% of the total population. Whether decompressed or not, most individuals with craniocervical junction issues after infancy had a normal outcome, without long-term neurological sequelae (57/77, 74.0%). The remaining 20 had various long-term neurological issues. This is the first cohort based estimate of risks related to the upper cervical spine in individuals with achondroplasia specifically beyond infancy.

Cervical Myeloradiculopathy and Atlantoaxial Instability in Cervical Dystonia.

OBJECTIVE: Atlantoaxial instability, although rarely reported in the literature, can be associated with cervical dystonia (CD) and may lead to compression of the cord at the craniovertebral junction. We present a case series of 4 patients of longstanding CD with neurologic complications. Treatment strategies and challenges are discussed. METHODS: Retrospective analysis of 4 cases of longstanding CD with complications of myelopathy or radiculopathy. RESULTS: The average age at onset of complications was 28 years (range, 17-37). The average duration of CD was 23.75 years. Narrowing of the craniovertebral junction was seen in 3 patients, of which 2 had os odontoideum, and 1 had rotational malalignment at the atlantoaxial joint. One patient had disc desiccation with bulge and intramedullary signal changes in the cord at C3-4 level. Medical treatment was not satisfactory, but botulinum toxin was partly useful in all. One patient had sequelae of myelopathy and did recover partially after deep brain stimulation. Of the 2 patients who underwent surgical fixation with a fusion of the spine, one improved, and the other had no improvement due to irreversible cord damage. The overall outcome was satisfactory only in 2 patients. CONCLUSIONS: Early-onset CD can lead to cord complications at a young age and at higher levels of the cervical spine and at the cervicovertebral junction. Comprehensive management by a multidisciplinary team is crucial to prevent complications early.

Outcome of Osteophytes After Only-Fixation as Treatment for Multilevel Cervical Spondylosis-A Minimum of 12 Months Follow-Up.

OBJECTIVE: This report analyzes the significance of osteophytes in the overall pathologic scheme in patients with single-level or multilevel cervical spinal degeneration. METHODS: From January 2010 to December 2018, 249 patients with cervical spondylosis were surgically treated. The alterations in ventral compression caused by disc bulges, osteophytes, and ligament buckling (disc-osteophye-ligament [DOL] complex) at single or multiple levels were evaluated after surgical treatment that involved only spinal fixation and did not involve any kind of bone or soft tissue decompression. Delayed (≥1 year after surgery) postoperative imaging was available in 165 patients and these patients formed the study group. Forty-five patients underwent facet distraction arthrodesis (group A), 106 patients underwent only-fixation involving transarticular screw insertion (group B), and 14 patients underwent hybrid fixation that involved both intra-articular spacers and transarticular fixation techniques (group C) as the surgical treatment. RESULTS: The size of the DOL complex at the segments that underwent fixation was reduced in 136 patients. The size of the DOL complex or its related dural or neural compression did not increase in any of the cases evaluated. Reduction in the size of DOL was more pronounced in patients in group A in both immediate postoperative and delayed images and in patients in group C at spinal levels at which facet distraction was performed using facet distraction spacers. CONCLUSIONS: Spinal stabilization reduces the size of osteophytes. Facet distraction spacers are more effective in reduction of the size of DOL in both immediate and delayed postoperative periods.

Biomechanical comparison of spinal cord compression types occurring in Degenerative Cervical Myelopathy.

BACKGROUND: Degenerative Cervical Myelopathy results from spine degenerations narrowing the spinal canal and inducing cord compressions. Prognosis is challenging. This study aimed at simulating typical spinal cord compressions observed in patients with a realistic model to better understand pathogenesis for later prediction of patients' evolution. METHODS: A 30% reduction in cord cross-sectional area at C5-C6 was defined as myelopathy threshold based on Degenerative Cervical Myelopathy features from literature and MRI measurements in 20 patients. Four main compression types were extracted from MRIs and simulated with a comprehensive three-dimensional finite element spine model. Median diffuse, median focal and lateral types were modelled as disk herniation while circumferential type additionally involved ligamentum flavum hypertrophy. All stresses were quantified along inferior-superior axis, compression development and across atlas-defined spinal cord regions. FINDINGS: Anterior gray and white matter globally received the highest stress while lateral pathways were the least affected. Median diffuse compression induced the highest stresses. Circumferential type focused stresses in posterior gray matter. Along inferior-superior axis, those two types showed a peak of constraints at compression site while median focal and lateral types showed lower values but extending further. INTERPRETATION: Median diffuse type would be the most detrimental based on stress amplitude. Anterior regions would be the most at risk, except for circumferential type where posterior regions would be equally affected. In addition to applying constraints, ischemia could be a significant component explaining the early demyelination reported in lateral pathways. Moving towards patient-specific simulations, biomechanical models could become strong predictors for degenerative changes.

The Impact of Anterior Spondylolisthesis and Kyphotic Alignment on Dynamic Changes in Spinal Cord Compression and Neurological Status in Cervical Spondylotic Myelopathy: A Radiological Analysis Involving Kinematic CT Myelography and Multimodal Spinal Cord Evoked Potentials.

STUDY DESIGN: A retrospective study of prospectively collected data. OBJECTIVE: This study aimed to examine how radiological parameters affect dynamic changes in the cross-sectional area of the spinal cord (CSA) in cervical spondylotic myelopathy (CSM) patients and how they correlate with the severity of myelopathy, by evaluating multi-modal spinal cord evoked potentials (SCEPs). SUMMARY OF BACKGROUND DATA: Appropriate assessments of dynamic factors should reveal hidden spinal cord compression and provide useful information for choosing surgical procedures. METHODS: Seventy-nine CSM patients were enrolled. They were examined with kinematic CT myelography (CTM), and the spinal levels responsible for their CSM were determined via SCEP examinations. The C2-7 angle, C2-7 range of motion, and percentage of slip were measured on the midsagittal view during flexion and extension, and the CSA was measured on the axial view in each neck position using kinematic CTM. The patients who exhibited the smallest CSA values during extension and flexion were classified into Groups E and F, respectively. RESULTS: Fifty-two (65.8%) and 27 (34.2%) cases were included in Groups E and F, respectively. The preoperative JOA score did not differ significantly between the groups; however, the preoperative lower-limb JOA score of Group F was significantly lower than that of Group E (2.24 ±â€Š0.82 vs. 2.83 ±â€Š1.09, P = 0.016). In the multiple logistic regression analysis, a small C2-7 angle during extension (ß = 5°, odds ratio: 0.69, 95% confidence interval [CI]: 0.54-0.90) and the slip percentage during flexion (ß = 5%, odds ratio: 1.42, 95% CI: 1.09-1.85) were identified as significant predictors of belonging to Group F. CONCLUSION: Exhibiting more severe spinal cord compression during neck flexion was associated with a small C2-7 angle and anterior spondylolisthesis. The neurological status of the patients in Group F was characterized by severe lower limb dysfunction because of a disturbed blood supply to the anterior column.Level of Evidence: 4.

Intervertebral foramen narrowing during vertical dynamic loading.

OBJECTIVE: The goal of the present study was to examine the effect of vertebral body fracture on the InterVertebral Foraminal IVF parameters with an input acceleration to the seat bottom in the inferior-to-superior direction. METHODS: A series of 43 isolated lumbar spines underwent vertical dynamic loading using the vertical accelerative device to determine the influence of inferior to superior loading through the lumbar spine on the intervertebral foramen (IVF) geometries. Existence of foraminal stenosis was quantified using pre- and post-test computed tomography (CT) images. Foraminal height (IVF_Ht) and posterior disk height (PD_Ht) were the key IVF parameters. RESULTS: There was a significant (p < 0.05) decrease in the post-test IVF measurements compared to the pretest measurements. Furthermore, 30% of the total 49 AIS 2 cases and 70% of the total 21 AIS 3 cases had IVF values below the literature reported thresholds for IVF_Ht of < 15 mm and PD_Ht of < 4 mm, indicating likely occurrence of foraminal stenosis. CONCLUSIONS: These results underscore the need to assess foraminal geometry in compression fractures of the lumbar spine from vertical dynamic loading.

A movement disorder specialist gets a taste of his own medicine.

We present a case in which a movement disorder neurologist developed two different hyperkinetic movements due to corticospinal tract hyperexcitability, which resolved completely with surgical removal of an epidural spinal canal tumor. The first-hand description of these movements creates a unique opportunity for enhanced insight into these complex movement phenomena.

Minimal Access vs. Open Spine Surgery in Patients With Metastatic Spinal Cord Compression - A One-Center Randomized Controlled Trial.

BACKGROUND/AIM: We conducted a randomized controlled trial to investigate whether minimally access spine surgery (MASS) is less morbid than open surgery (OS) in patients with metastatic spinal cord compression (MSCC). PATIENTS AND METHODS: A total of 49 MSCC patients were included in the trial. The outcome measures were bleeding (L), operation time (min), re-operations and prolonged wound healing. RESULTS: The median age was 67 years (range=42-85 years) and 40% were men. The peri-operative blood loss in the MASS-group was significantly lower than that in the OS-group; 0.175L vs. 0.500L, (p=0.002). The median operation time for MASS was 142 min (range=72-203 min) vs. 103 (range=59-435 min) for OS (p=0.001). There was no significant difference between the two groups concerning revision surgery or delayed wound healing. CONCLUSION: The MASS technique in MSCC patients is associated with less blood loss, but a longer operation time when compared to the OS technique.

Clinical Application of a New Assessment Tool for Myelopathy Hand Using Virtual Reality.

STUDY DESIGN: A cross-sectional study. OBJECTIVE: To assess the effectiveness of a new assessment tool, myelopathy-hand functional evaluation system (MFES), in evaluating the hand dysfunction of patients with cervical myelopathy in the 10-second grip-and-release test (10 second G-R test). SUMMARY OF BACKGROUND DATA: Clumsy fingers movement is a common symptom of myelopathy patients. Evaluating the impaired hand function can provide a strong basis in assessing the severity of myelopathy. Currently, no objective and effective evaluation method is widely accepted in clinical practice. METHODS: MFES mainly consists of a pair of wise-gloves and a computer with software. One hundred and ninety-eight consecutive participants were asked to wear the wise-gloves and then perform 10 seconds G-R test. The movements of each finger were recorded by MFES and converted into waveforms. Relevant waveform parameters were measured and analyzed. The Japanese Orthopedics Association (JOA) scores of each patient were marked and the maximum spinal cord compression (MSCC) was measured on midsagittal T2-weighted magnetic resonance imaging (MRI). RESULTS: Myelopathy patients had a lower number of G-R cycles and a longer time per cycle than healthy subjects. There were significant differences in adduction and abduction time in patients with JOA scores greater than 6, but not in healthy subjects and patients with JOA scores less than 6. The waveforms of ulnar three fingers in myelopathy patients were lower and wider than those in healthy individuals. The average ratio value of wave height to wave width (a/b) could quantitatively reflect such differences of waveforms. According to receiver operating characteristic (ROC) curve analysis, the optimal threshold value of the normal average ratio was more than 1.92. The average a/b value was correlated with the JOA scores of the motor function in the upper extremities (r = 0.842). CONCLUSION: MFES appears to be an objective and quantitative assessment tool for patients with cervical myelopathy. LEVEL OF EVIDENCE: 3.