Abstract
ObjectivesTo update a previously established list of predictors for neurological cervical cord dysfunction in nonmyelopathic degenerative cervical cord compression (NMDCCC).Material and MethodsA prospective observational follow‐up study was performed in a cohort of 112 consecutive NMDCCC subjects (55 women and 57 men; median age 59 years, range 40–79 years), either asymptomatic (40 subjects) or presenting with cervical radiculopathy or cervical pain (72 subjects), who had completed a follow‐up of at least 2 years (median duration 3 years). Development of clinical signs of degenerative cervical myelopathy (DCM) as the main outcome was monitored and correlated with a large number of demographic, clinical, electrophysiological, and MRI parameters including diffusion tensor imaging characteristics (DTI) established at entry.ResultsClinical evidence of the first signs and symptoms of DCM were found in 15 patients (13.4%). Development of DCM was associated with several parameters, including the clinical (radiculopathy, prolonged gait and run‐time), electrophysiological (SEP, MEP and EMG signs of cervical cord dysfunction), and MRI (anteroposterior diameter of the cervical cord and cervical canal, cross‐sectional area, compression ratio, type of compression, T2 hyperintensity). DTI parameters showed no significant predictive power. Multivariate analysis showed that radiculopathy, cross‐sectional area (CSA) ≤ 70.1 mm2, and compression ratio (CR) ≤ 0.4 were the only independent significant predictors for progression into symptomatic myelopathy.ConclusionsIn addition to previously described independent predictors of DCM development (radiculopathy and electrophysiological dysfunction of cervical cord), MRI parameters, namely CSA and CR, should also be considered as significant predictors for development of DCM.
Highlights
Degenerative cervical cord compression detected by imaging methods, mostly magnetic resonance imaging (MRI), is a prerequisite for the clinical diagnosis of degenerative cervical myelopathy (DCM)
The study sample here consisted of a cohort of consecutive subjects who had been referred to the Department of Neurology between January 2012 and December 2013 with clinical signs and symptoms of cervical radiculopathy, moderate-to-severe chronic or intermittent axial cervical pain, and volunteers in whom MRI signs of degenerative cervical cord compression had previously been detected during an epidemiological study focusing on the prevalence of degenerative cervical cord compression in the population of the province of South Moravia (Kovalova et al, 2016)
In a sample of subjects with NMDCC that included individuals with no signs and symptoms related to degeneration of the cervical spine, it emerged that cervical radiculopathy is the most important independent predictor for development of DCM
Summary
Degenerative cervical cord compression detected by imaging methods, mostly magnetic resonance imaging (MRI), is a prerequisite for the clinical diagnosis of degenerative cervical myelopathy (DCM) This overarching term is preferred to describe the various degenerative conditions of the cervical spine that cause myelopathy, including most frequent cervical spondylotic myelopathy, and degenerative disc disease and ossification of the posterior longitudinal ligament and of the ligamentum flavum (Nouri, Tetreault, Singh, Karadimas, & Fehlings, 2015). As well as the frequency, of myelopathy development, and of risk factors influencing this progression, is sparse (Wilson et al, 2013) Such knowledge would be of crucial importance to the practical management of asymptomatic degenerative cervical cord compression, and bear upon the important issue of indications for preventive surgical decompression
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