PURPOSE: Intraepidermal nerve fiber density (IENFD) is useful in the evaluation of small-fiber neuropathy (SFN). Recent guidelines recommend extending the spectrum of controls for IENFD assessment by evaluation of patients whose clinical picture mimics that of SFN. The aim of this study was to broaden the spectrum of IENFD controls by the assessment of patients with cervical spondylotic myelopathy (CSM) and painful feet. METHODS: Evaluation of IENFD from skin biopsy samples and quantitative sensory testing (QST) were performed in a cohort of 14 CSM patients (eight men, median age: 58; range: 46-63 years), with painful feet, exhibiting no clinical or electrophysiological signs of large-fiber polyneuropathy, and no risk factors for peripheral neuropathies. RESULTS: Quantitative sensory testing abnormalities were found in all but two of the CSM patients (86%), while the IENFD values were within reference range. The mean IENFD value (6.87 ± 2.78 fibers/mm) did not differ from that of an age- and sex-matched cohort of healthy volunteers (7.97 ± 2.21 fibers/mm, P > 0.05). CONCLUSIONS: The study confirmed normal skin biopsy findings in patients with CSM as one of the clinical conditions mimicking SFN and provided further support for the use of IENFD assessment in case of suspicion of SFN.

Department of Neurology University Hospital Brno Jihlavska 20 62500 Brno Czech Republic; Central European Institute of Technology Masaryk University Brno Czech Republic

Zobrazit více v PubMed

Bednarík, J. , Kadanka Z., Vohánka S., Stejskal L., Vlach O., and Schröder R.. 1999. The value of somatosensory‐ and motor‐evoked potentials in predicting and monitoring the effect of therapy in spondylotic cervical myelopathy. Prospective randomized study. Spine (Phila Pa 1976) 24:1593–1598. PubMed

Benzel, E. C. , Lancon J., Kesterson L., and Hadden T.. 1991. Cervical laminectomy and dentate ligament section for cervical spondylotic myelopathy. J. Spinal Disord. 4:286–295. PubMed

Bursova, S. , Vlckova E., Hnojcikova M., Nemec M., Dubovy P., Micankova‐Adamova B., et al. 2012. Intraepidermal nerve fiber density assessment in skin biopsy – normative values. Cesk. Slov. Neurol. N. 75:455–459.

Emery, S. E. 2001. Cervical spondylotic myelopathy: diagnosis and treatment. J. Am. Acad. Orthop. Surg. 9:376–388. PubMed

England, J. D. , Gronseth G. S., Franklin G., Carter G. T., Kinsella L. J., Cohen J. A., et al. 2009. Evaluation of distal symmetric polyneuropathy: the role of autonomic testing, nerve biopsy, and skin biopsy (an evidence‐based review). Muscle Nerve 39:106–115. PubMed

Herrmann, D. N. , O'Connor A. B., Schwid S. R., Da Y., Goodman A. D., Rafferty J., et al. 2010. Broadening the spectrum of controls for skin biopsy in painful neuropathies. Muscle Nerve 42:436–438. PubMed

Lacomis, D. 2002. Small‐fiber neuropathy. Muscle Nerve 26:173–188. PubMed

Lauria, G. , Bakkers M., Schmitz C., Lombardi R., Penza P., Devigili G., et al. 2010a. Intraepidermal nerve fiber density at the distal leg: a worldwide normative reference study. J. Peripher. Nerv. Syst. 15:202–207. PubMed

Lauria, G. , Hsieh S. T., Johansson O., Kennedy W. R., Leger J. M., Mellgren S. I., et al. 2010b. European Federation of Neurological Societies/Peripheral Nerve Society Guideline on the use of skin biopsy in the diagnosis of small fiber neuropathy. Report of a joint task force of the European Federation of Neurological Societies and the Peripheral Nerve Society. Eur. J. Neurol. 17:903–912. PubMed

Magerl, W. , Krumova E. K., Baron R., Tölle T., Treede R. D., and Maier C.. 2010. Reference data for quantitative sensory testing (QST): refined stratification for age and a novel method for statistical comparison of group data. Pain 151:598–605. PubMed

Peters, M. J. , Bakkers M., Merkies I. S., Hoeijmakers J. G., van Raak E. P., and Faber C. G.. 2013. Incidence and prevalence of small‐fiber neuropathy: a survey in the Netherlands. Neurology 81:1356–1360. PubMed

Rolke, R. , Baron R., Maier C., Tölle T. R., Treede R. D., Beyer A., et al. 2006. Quantitative sensory testing in the German Research Network on Neuropathic Pain (DFNS): standardized protocol and reference values. Pain 123:231–243. PubMed

Skorna, M. , Kopacik R., Vlckova E., Adamova B., Kostalova M., and Bednarik J.. 2015. Small nerve fiber pathology in critically illness documented by serial skin biopsies. Muscle Nerve 52:28–33. PubMed

Srotova, I. , Vlckova E., Strakova J., Kincova S., Adamova B., Dusek L., et al. 2015. Validation of Czech version of DFNS protocol for quantitative sensory testing]. Cesk. Slov. Neurol. N. 78:442–452.

Vlckova‐Moravcova, E. , Bednarik J., Dušek L., Toyka K. V., and Sommer C.. 2008. Diagnostic validity of epidermal nerve fiber densities in painful sensory neuropathies. Muscle Nerve 37:50–60. PubMed

Yonenobu, K. , Abumi K., Takeomi E., and Ueyama K.. 2001. Interobserver and intraobserver reliability of the Japanese Orthopaedic Association scoring system for evaluation of cervical compression myelopathy. Spine (Phila Pa 1976) 26:1890–1894. PubMed

Yoshiyama, Y. , Tokumaru Y., Hattori T., and Hirayama K.. 1995. The “pseudo‐polyneuropathy” type sensory disturbances in cervical spondylotic myelopathy. Rinsho Shinkeigaku (Clin. Neurol.) 35:141–146. PubMed