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Presymptomatic spondylotic cervical myelopathy: an updated predictive model

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Abstract

Spondylotic cervical cord compression detected by imaging methods is a prerequisite for the clinical diagnosis of spondylotic cervical myelopathy (SCM). Little is known about the spontaneous course and prognosis of clinically “silent” presymptomatic spondylotic cervical cord compression (P-SCCC). The aim of the present study was to update a previously published model predictive for the development of clinically symptomatic SCM, and to assess the early and late risks of this event in a larger cohort of P-SCCC subjects. A group of 199 patients (94 women, 105 men, median age 51 years) with magnetic resonance signs of spondylotic cervical cord compression, but without clear clinical signs of myelopathy, was followed prospectively for at least 2 years (range 2–12 years). Various demographic, clinical, imaging, and electrophysiological parameters were correlated with the time for the development of symptomatic SCM. Clinical evidence of the first signs and symptoms of SCM within the follow-up period was found in 45 patients (22.6%). The 25th percentile time to clinically manifested myelopathy was 48.4 months, and symptomatic SCM developed within 12 months in 16 patients (35.5%). The presence of symptomatic cervical radiculopathy and electrophysiological abnormalities of cervical cord dysfunction detected by somatosensory or motor-evoked potentials were associated with time-to-SCM development and early development (≤12 months) of SCM, while MRI hyperintensity predicted later (>12 months) progression to symptomatic SCM. The multivariate predictive model based on these variables correctly predicted early progression into SCM in 81.4% of the cases. In conclusion, electrophysiological abnormalities of cervical cord dysfunction together with clinical signs of cervical radiculopathy and MRI hyperintensity are useful predictors of early progression into symptomatic SCM in patients with P-SCCC. Electrophysiological evaluation of cervical cord dysfunction in patients with cervical radiculopathy or back pain is valuable. Meticulous follow-up is justified in high-risk P-SCCC cases.

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References

  1. Bednarik J, Kadanka Z, Dusek L, Novotny O, Surelova D, Urbanek I, Prokes B (2004) Presymptomatic spondylotic cervical cord compression. Spine 29:2260–2269

    Article  PubMed  Google Scholar 

  2. Bednarik J, Kadanka Z, Vohanka S, Novotny O, Surelova D, Filipovicova D, Prokes B (1998) The value of somatosensory and motor evoked evoked potentials in pre-clinical spondylotic cervical cord compression. Eur Spine J 7:493–500

    Article  PubMed  CAS  Google Scholar 

  3. Benzel EC, Lancon J, Kesterson L, Hadden T (1991) Cervical laminectomy and dentate ligament section for cervical spondylotic myelopathy. J Spinal Disord 4:286–295

    PubMed  CAS  Google Scholar 

  4. Bland JM, Altman DG (1986) Statistical methods for assessing agreement between two methods of clinical measurement. Lancet 1:307–310

    PubMed  CAS  Google Scholar 

  5. Bland JM, Altman DG (1999) Measuring agreement in method comparison studies. Stat Methods Med Res 8:135–160

    Article  PubMed  CAS  Google Scholar 

  6. Boden SD, McCowin PR, Davis DO, Dina TS, Mark AS, Wiesel S (1990) Abnormal magnetic-resonance scans of the cervical spine in asymptomatic subjects. J Bone Joint Surg Am 72:1178–1184

    PubMed  CAS  Google Scholar 

  7. Fujiwara K, Yonenobu K, Ebara S (1989) The prognosis of surgery for spondylotic cervical myelopathy. J Bone Joint Surg Br 71:393–398

    PubMed  CAS  Google Scholar 

  8. Fukushima T, Ikata T, Taoka I, Takata S (1991) Magnetic resonance imaging study on spinal cord plasticity in patients with cervical compression myelopathy. Spine 16(Suppl):534–538

    Article  Google Scholar 

  9. Golash A, Birchall D, Laitt RD, Jackson A (2001) Significance of CSF area measurement in cervical spondylitic myelopathy. Br J Neurosurg 15:17–21

    Article  PubMed  CAS  Google Scholar 

  10. Gore DR, Sepic SB (1984) Anterior cervical fusion for degenerated or protruded discs. A review of one hundred forty-six patients. Spine 9:667–671

    Article  PubMed  CAS  Google Scholar 

  11. Heckmann JG, Lang CJ, Zobelein I, Laumer R, Druschky A, Neundörfer B (1999) Herniated cervical intervertebral discs with radiculopathy: an outcome study of conservatively or surgically treated patients. J Spinal Disord 12:396–401

    PubMed  CAS  Google Scholar 

  12. Herkowitz H, Kurz LT, Overholt DP (1990) Surgical management of cervical soft disc herniation: a comparison between the anterior and posterior approach. Spine 15:1026–1030

    Article  PubMed  CAS  Google Scholar 

  13. Kadanka Z, Kerkovsky M, Bednarik J, Jarkovsky J (2008) Cross-sectional transverse area and hyperintensities on MRI in relation to the clinical picture in cervical spondylotic myelopathy. Spine 32:2573–2577

    Google Scholar 

  14. Kameyama T, Ando T, Yanagi T, Hashizume Y (1995) Neuroimaging and pathology of the spinal cord in compressive cervical myelopathy. Rinsho Byori 43:886–890

    PubMed  CAS  Google Scholar 

  15. Kanchiku T, Taguchi T, Kaneko K, Fuchigami Y, Yonemura H, Kawai S (2001) A correlation between magnetic resonance imaging and electrophysiological findings in cervical spondylotic myelopathy. Spine 26:294–299

    Article  Google Scholar 

  16. Koyanagi T, Hirabayashi K, Satomi K, Toyama Y, Fujimura Y (1993) Predictability of operative results of cervical compression myelopathy based on preoperative computed tomography myelopathy. Spine 18:1958–1963

    Article  PubMed  CAS  Google Scholar 

  17. Lo YL, Chan LL, Lim W, Tan SB, Tan CT, Chen JLT, Fook-Chong S, Ratnagopal P (2006) Transcranial magnetic stimulation screening for cord compression in cervical spondylosis. J Neurol Sci 244:17–21

    Article  PubMed  CAS  Google Scholar 

  18. Manabe S, Tateishi A (1986) Epidural migration of extruded cervical disc and its surgical treatment. Spine 11:873–878

    Article  PubMed  CAS  Google Scholar 

  19. Matsuda Y, Miyazaki K, Tada K, Yasuda A, Nakayama T, Murakami H, Matsuo M (1991) Increased MR signal intensity due to cervical myelopathy: analysis of 29 surgical cases. J Neurosurg 74:887–892

    Article  PubMed  CAS  Google Scholar 

  20. Matsumoto M, Fujimura Y, Suzuki N, Nishi Y, Nakamura M, Yabe Y, Shiga H (1998) MRI and cervical intervertebral discs in asymptomatic subjects. J Bone Joint Surg Br 80:19–24

    Article  PubMed  CAS  Google Scholar 

  21. Matsuyama Y, Kawakami N, Mimatsu K (1995) Spinal cord expansion after decompression in cervical myelopathy. Investigation by computed tomography myelography and ultrasonography. Spine 20:1657–1663

    PubMed  CAS  Google Scholar 

  22. Mehalic TF, Pezzuti RT, Applebaum BI (1990) Magnetic resonance imaging and cervical spondylotic myelopathy. Neurosurgery 26:217–227

    Article  PubMed  CAS  Google Scholar 

  23. Okada Y, Ikata T, Yamada H, Sakamoto R, Katoh S (1993) Magnetic resonance imaging study on the results of surgery for surgical compression myelopathy. Spine 14:2024–2029

    Article  Google Scholar 

  24. Penning L, Wilmink JT, Van Woerden HH, Knol E (1986) CT myelographic findings in degenerative disorders of the cervical spine: clinical significance. AJR Am J Roentgenol 146:793–801

    PubMed  CAS  Google Scholar 

  25. Rao R (2002) Neck pain, cervical radiculopathy, and cervical myelopathy: pathophysiology, natural history, and clinical evaluation. J Bone Joint Surg Am 84:1872–1881

    PubMed  Google Scholar 

  26. Saal JS, Saal JA, Yurth EF (1996) Nonoperative management of herniated cervical intervertebral disc with radiculopathy. Spine 21:1877–1883

    Article  PubMed  CAS  Google Scholar 

  27. Takahashi M, Yamashita Y, Sakamoto S, Kojima R (1989) Chronic cervical cord compression: clinical significance of increased signal hyperintensity on MR images. Radiology 173:219–224

    PubMed  CAS  Google Scholar 

  28. Teresi LM, Lufkin RB, Reicher MA, Moffit BJ, Vinuela FV, Wilson GM, Bentson JR, Hanafee WN (1987) Asymptomatic degenerative disc disease and spondylosis of the cervical spine: MR imaging. Radiology 164:83–88

    PubMed  CAS  Google Scholar 

  29. Wada E, Yonenobu K, Suzuki S, Kanazawa A, Ochi T (1999) Can intramedullary signal change on magnetic resonance imaging predict surgical outcome in cervical spondylotic myelopathy? Spine 24:455–462

    Article  PubMed  CAS  Google Scholar 

  30. Yu YL, Boulay JM, Stevens JM, Kendall BE (1986) Computer-assisted myelography in cervical spondylotic myelopathy and radiculopathy. Brain 109:259–278

    Article  PubMed  Google Scholar 

  31. Yue WM, Tan SB, Tan MH, Koh DC, Tan CT (2001) The Torg-Pavlov Ratio in cervical spondylotic myelopathy: a comparative study between patients with cervical spondylotic myelopathy and a nonspondylotic, nonmyelopathic population. Spine 26:1760–1764

    Article  PubMed  CAS  Google Scholar 

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Acknowledgments

The study was supported by the Internal Grant Agency of the Ministry of Health of the Czech Republic (NR 7993-5/2004) and by the Research Plan of the Czech Ministry of Education No. MSM0021622404. Ethical approval for the study was granted by the institutional ethical committee. The authors thank to Dr. Andrea Sprlakova for her help in evaluation of interobserver variability.

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Authors and Affiliations

  1. Department of Neurology, Faculty Hospital Brno and Medical Faculty of the Masaryk University, Jihlavská 20, 625 00, Brno, The Czech Republic

    Josef Bednarik, Zdenek Kadanka, Stanislav Vohanka, Oldrich Novotny, Igor Urbanek & Dagmar Kratochvilova

  2. Institute of Biostatistics and Analyses, Masaryk University, Brno, The Czech Republic

    Ladislav Dusek

  3. Department of Radiology, Faculty Hospital and Medical Faculty of the Masaryk University, Brno, The Czech Republic

    Milos Kerkovsky

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  1. Josef Bednarik
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  2. Zdenek Kadanka
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  4. Milos Kerkovsky
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  5. Stanislav Vohanka
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  8. Dagmar Kratochvilova
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Correspondence to Josef Bednarik.

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Bednarik, J., Kadanka, Z., Dusek, L. et al. Presymptomatic spondylotic cervical myelopathy: an updated predictive model. Eur Spine J 17, 421–431 (2008). https://doi.org/10.1007/s00586-008-0585-1

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  • DOI: https://doi.org/10.1007/s00586-008-0585-1

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