Clinical Analysis Of "pseudo-polyneuropathy Type" Cervical Spondylosis

Purpose of study To study the clinical features of"Pseudo-polyneuropathy type"cervical spondylosis (PCS) and finding evidence for its diagnosis and differential diagnosis.Methods 1. Retrospective study was performed on 28 cervical spondylotic patients, with complaints of distal sensory disturbance and admitted to the Union hospital during the time period 2005 and 2009. Based on their symptoms, signs, clinical diagnosis and MRI based evidence, these 28 patients were divided into 2 groups namely, CSM(cervical spondylotic myelopathic)group comprising 15 patients and PCS("pseudo-polyneuropathy type"cervical spondylotic) group with 13 patients. Electrophysiological testings[EMG (electromyography), SCV(sensory conduction velocity),MCV(motor conduction velocity),F-wave latencies and EPs(Evoked potentials for MEP and SSEP)]; clinical characteristics of the sensory disturbance, Hoffmann and Babinski signs and MRI data concerning the degenerative changes of cervical spondylosis were studied and analysed. 2. A follow-up via phone inquiry and subsequent out-patient visits of some of these patients were also carried out to assess the clinical course of this distal sensory impairment.Results The distal sensory disturbance distribution in both CSM and PCS groups were mainly bilateral than unilateral(x2 = 16.3(p<0.05) ,x2 = 6.23(p<0.05) respectively).In both CSM and PCS groups, bar chart analysis revealed upper distal extremities were more involved followed by simultaneous upper and lower distal extremities involvement. In both groups all affected extremities displayed pinprick (superficial) sensation decrease while vibration(deep)impairment was predominant only in the lower extremities. In the CSM group Hoffmann sign was elicited in 80% of the patients, Babinski was present in all the patients and in the PCS group, 55% of the patients displayed Hoffmann sign and none had Babinski sign. In both groups, for all tested muscles and nerves combined, EMG and MCV rates were normal while SCV normal rate was 96.94%。6 patients in the PCS group and 4 patients in the CSM who were evaluated for F-wave latencies displayed normal values. EPs for MEP and SSEP that were tested for 10 patients in the CSM group and 5 patients(only SSEP) in the PCS group were abnormal. MRI analysis in both groups revealed degenerative changes highest at C5-6 levels, followed by C4-5 and C6-7. Degenerative changes like DD(disc degeneration)-DP( disc protrusion),and DP( disc protrusion)- (SS)cervical spinal canal stenosis at these levels in both groups also follow a linear correlation. Follow-up of the 6 patients in CSM group revealed distal sensory disturbance improved in 1 case who had surgery but no significant improvement in the other 5 who had conservative treatment。In the PCS group, the 8 patients followed, 5 had sensory symptoms stable and 3 had a waxing and waning course of their sensory symptoms.Conclusion Following this study it is felt, the distal sensory complaints occuring in cervical spondylotic patients is a rare form of"pseudo-polyneuropathy"type cervical spondylosis(PCS) and the cause lie at the cervical cord level. The mechanism is probably ischaemic in nature. Furthermore, electrophysiological studies like EMG and SSEP play an important role in its diagnosis and differential diagnosis.