How has electrophysiology changed the management of cervical spondylotic myelopathy?

Cervical spondylosis occurs universally, with cervical spondylotic myelopathy (CSM) as its most serious consequence. The electrical property of the spinal cord and its susceptibility to injury renders electrophysiology relevant to the management of CSM, as addressed in this review. Somatosensory-evoked potentials evaluate spinal cord integrity with regards to posterior column functions exclusively. Although motor-evoked potentials may be more sensitive than the former and may be utilized intraoperatively, they are susceptible to interference by inhalational anaesthetics. Electromyography may play a role in minimizing C5 root damage and spinal cord-evoked potentials can localize spinal conduction block during CSM surgery. Critically reviewing the available evidence, electrophysiology cannot be universally recommended as mandatory in the management of CSM at present. It may, however, play emergent, isolated roles in the diagnosis, follow-up and treatment of this common disorder.