BACKGROUND: Asymptomatic degenerative cervical cord compression (ADCC) represents a premyelopathic stage of degenerative cervical myelopathy (DCM), with high prevalence in older age and unclear management. Contact heat-evoked potentials (CHEPs) assess the integrity of the thermo-algesic somatosensory pathway and have shown the highest sensitivity among neurophysiological methods in detecting dysfunction in the centromedial and anterior spinal cord in DCM. METHODS: This cross-sectional cohort study evaluated the utility of upper extremity dermatomal C4, C6 and C8 CHEPs (dCHEPs) compared to standard neurophysiological methods-median and tibial nerves somatosensory evoked potentials (SEPs), upper and lower extremity motor evoked potentials (MEPs), and electromyography (EMG)-for detecting subclinical cervical cord dysfunction in ADCC. Two cohorts were included: 82 ADCC patients (mean age 53.7 ± 9.8 years; 53 females) and 10 DCM patients (mean age 64.0 ± 7.9 years; 4 females). All underwent bilateral dCHEPs (C4, C6, C8), SEPs, MEPs, and EMG (C5-C8 myotomes). RESULTS: dCHEPs abnormalities were found in 50% of ADCC patients, exceeding the rates for SEPs (32.1%), MEPs (21.8%), and EMG (13.9%). In 20.7%, dCHEPs were the only abnormal neurophysiological finding. In the DCM cohort, dCHEPs were abnormal in 80%, and were the only abnormality in 20%. In both groups, abnormalities were most frequent in the C8 dermatome. CONCLUSIONS: dCHEPs demonstrated superior sensitivity in detecting cervical cord dysfunction, not only in DCM but also in ADCC. As a functional complement to MRI, they may aid in identifying early spinal cord involvement. Their prognostic role in ADCC warrants further study.

Department of Neurology University Hospital Brno Brno Czechia

Department of Radiology and Nuclear Medicine University Hospital Brno Brno Czechia

Faculty of Medicine Masaryk University Brno Czechia

Faculty of Medicine Palackého University Olomouc Czechia

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