Percutaneous magnetic coil stimulation of human cervical vertebral column: site of stimulation and clinical application

Abstract

In order to understand which neural elements are excited after percutaneous magnetic coil (MC) stimulation over the cervical vertebral column we have performed such study in 8 normal subjects and 4 patients. On moving the coil rostrocaudally up to 3 cm and horizontally up to 2 cm from the midline we found no change in the latencies of the compound muscle action potentials to biceps, deltoid, abductor pollicis brevis (APB) and abductor digiti minimi muscles indicating a fixed site of excitation of the spinal roots within the intervertebral foramina. F latencies to APB after stimulation of the median nerve at the wrist were always longer than the direct latencies obtained after cervical vertebral stimulation. The mean difference between indirect latency based on F technique and direct latency to APB was 0.45 msec which represented a distance of 2.7 cm distal to the anterior horn cells assuming a conduction velocity of 60 m/sec. MC stimulation in 2 patients suggested a diagnosis of cervical radiculopathy which was confirmed by imaging studies or operative findings. Both MC and needle root stimulation in one patient with diabetic brachial plexopathy and in another with diabetic polyneuropathy suggested that the needle stimulation occurred about 1.2-1.8 cm proximal to MC stimulation.