101. Prospective evaluation of degenerative cervical myelopathy in asymptomatic patients over 60 years

Abstract

BACKGROUND CONTEXT Degenerative cervical myelopathy (DCM) is caused by narrowing of the cervical spinal canal resulting in compression of the spinal cord. The diagnosis of DCM is confirmed by history, physical exam findings, and advanced imaging showing cord compression. Radcliff et al reported the incidence of undiagnosed DCM in hip fracture patients (18%) and elective hip replacement patients (0%) based on history, modified Japanese Orthopedic Association (mJOA) score, and physical exam. Other investigators have studied the specificity and sensitivity of physical exam findings for diagnosing DCM and found it to be imperfect, with 21% of patients diagnosed with DCM lacking obvious clinical signs. PURPOSE The purpose of this study was to determine the prevalence of undiagnosed DCM in patients over 60 years by combining history, physical exam, and MRI. STUDY DESIGN/SETTING Prospective case series. PATIENT SAMPLE Patients aged 60 years or older without history or current symptoms of DCM. OUTCOME MEASURES Central canal stenosis as measured by MRI, myelopathic symptoms on neurologic exam, and patient-reported outcomes (mJOA and neck disability index [NDI]). METHODS Patients 60 years and older were prospectively enrolled from primary care practices. Patients were excluded if they had a history of debilitating neck pain, inability to have a cervical MRI, neurologic disease, cognitive impairment, or prior cervical spine surgery. A cervical MRI was performed using a 3.0 Tesla imaging system and a cervical coil. NDI and mJOA scores were collected for all patients, as well as a thorough history and physical exam. MRI results were reviewed independently by an orthopedic spine surgeon and neuroradiologist. Central cervical canal stenosis was graded 0-3, with 0 indicating no canal stenosis and 3 indicating spinal cord compression with myelomalacia. Patients were diagnosed with DCM if they had myelopathic history (mJOA RESULTS Eighty patients were included in the study: 39 Males (48.8%) and 41 Females (51.2%). The average age was 68.6 years-old (range 60–90 years). The mean NDI was 2.5%, range 0-24%. The mean mJOA score for the cohort was 17.5 (range 14-18). Two patients (3.8%) had an mJOA score of 16. Two (2.5%) patients had myelomalacia on MRI but were asymptomatic. CONCLUSIONS In our study, the prevalence of cervical spinal cord compression in patients 60 years and older with minimal neck pain was found by MRI to be 37.5%. Among these patients, one was diagnosed with DCM, while two others had myelomalacia with a normal physical exam. Our data support the work of other researchers and show that patients may have MRI findings of myelomalacia but remain asymptomatic. This study confirms a small but important prevalence of spinal stenosis and spinal cord compression in patients over 60 who have minimal or no symptoms. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.