Response to the Letter to the Editor: Evaluation of the Association between Neck Pain and the Trapezius Muscles in Patients with Cervical Myelopathy Using Motor Evoked Potential: A Retrospective Study

Article information

Asian Spine J. 2024;18(1):160-161
Publication date (electronic) : 2024 February 26
doi :
1Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
2Department of Orthopaedic Surgery, National Center for Geriatrics and Gerontology, Obu, Japan
3Department of Orthopaedic Surgery, Nagoya Daini Red Cross Hospital, Nagoya, Japan
4Department of Orthopaedic Surgery, Konan Kosei Hospital, Konan, Japan
Corresponding author: Shiro Imagama, Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya 466-8560, Japan, Tel: +81-52-741-2111, Fax: +81-52-744-2260, E-mail:
Received 2023 December 20; Accepted 2023 December 23.

Thank you very much for your interest in our paper [1], “Evaluation of the association between neck pain and the trapezius muscles in patients with cervical myelopathy using motor evoked potential: a retrospective study.” Thank you very much for your very valuable comments. We responded to the best of our ability at this time.

1. First, we would like to appreciate the researcher for clearly and concisely describing the informative and interesting introduction part. It enhances our interest in studying more about neck pain and its association with the trapezius muscle in patients with cervical myelopathy using the motor-evoked potential, it helps us to become aware of the new information about the motor-evoked potential. The study shows that the stability of cervical vertebrae and the neck extensor muscles are important in the prevention of bending and rotation, which the reader can easily comprehend. In this scientific research, the introduction part was lacking the hypothesis of this study.

Response: Our study began with the following hypotheses: In patients with cervical myelopathy, preoperative neck pain is hypothesized to be associated with abnormal trapezius muscle activity.

2. Secondly, in the literature method and material section, there was no information about how to calculate the sample size for the research. In this scientific literature, the inclusion and exclusion criteria of the participants were not mentioned clearly. According to several studies, it is recommended to consider age and gender specifications when recruiting participants, as the aging process can lead to wear and tear of cervical ligaments. However, this study lacks literature discussing the area of neck pain (whether bilateral or unilateral), the stage of myelopathy, paraesthesia, and body mass index, as these factors can contribute to increased neck pain [2,3]. Furthermore, the study fails to specify exclusion criteria, and there is a lack of reference in the measurement section.

Response: The analysis was performed on the cases that could be collected, and sample size calculations were not available. Cases in which spinal cord monitoring was not possible due to epilepsy or other reasons were excluded. As you indicated, age and gender were not specified in this study, since there were no significant differences between the two groups. Thank you for providing us with this valuable literature. In this case, we did not conduct a detailed interview regarding the left and right sides with regard to neck pain. The preoperative Japanese Orthopaedic Association score is tabulated below, as is the BMI, although there are no clear stage criteria (Table 1). Our report on methods is similar [4].

Preoperative JOA score and BMI

3. Third, in the results section, there was a lack of assessment of data normality, and even duplication of data was observed [5]. Moreover, this research article did not clearly address confounding factors for latency, amplitude, and cross-sectional area.

Response: As you point out, we were not able to examine those confounding factors.


Conflict of Interest

No potential conflict of interest relevant to this article was reported.

Author Contributions

All authors provided the same amount of effort for the preparation of this commentary.


1. Ito S, Sakai Y, Harada A, et al. Evaluation of the association between neck pain and the trapezius muscles in patients with cervical myelopathy using motor evoked potential: a retrospective study. Asian Spine J 2021;15:604–10.
2. Ishii T, Hara T, Kusano S, Miura K, Kubo A, Kosaka J. Positive association between the cross-sectional area of the rhomboid muscle, and the range of shoulder abduction after neck dissection surgery. Phys Ther Res 2018;21:39–43.
3. Kocur P, Tomczak M, Wiernicka M, Goliwas M, Lewandowski J, Lochynski D. Relationship between age, BMI, head posture and superficial neck muscle stiffness and elasticity in adult women. Sci Rep 2019;9:8515.
4. Ito S, Ando K, Kobayashi K, et al. Larger muscle mass of the upper limb correlates with lower amplitudes of deltoid MEPs following transcranial stimulation. J Clin Neurosci 2020;81:426–30.
5. Mishra P, Pandey CM, Singh U, Gupta A, Sahu C, Keshri A. Descriptive statistics and normality tests for statistical data. Ann Card Anaesth 2019;22:67–72.

Article information Continued

Table 1.

Preoperative JOA score and BMI

Neck pain (+) (VAS score ≥50) Neck pain (-) (VAS score <50) p-value
No. of patients 31 69
BMI 24.1±3.1 24.0±2.9 0.833
Preoperative JOA score 10.5±3.0 11.9±2.4 0.013

Values are presented as number or mean±standard deviation.

JOA, Japanese Orthopaedic Association; BMI, body mass index.