Publication details

Spondylotic cervical myelopathy - most frequent cause of myelopathy. Imaging studies



Year of publication 2005
Type Article in Periodical
Magazine / Source European Journal of Neurology
MU Faculty or unit

Faculty of Medicine

Field Neurology, neurosurgery, neurosciences
Keywords Spondylotic cervical myelopathy; epidemiology; imaging studies
Description Cervical spondylotic myelopathy (CSM) is the most frequent cause of cervical myelopathy in the population over 50 years of age and even over 15 years of age (CSM- 23.6%, spinal tumour 16.4%, multiple sclerosis 17.8%, motor neurone disease 4.1%). In spite of its frequency, it is an underdiagnosed disease. To our knowledge there are no randomised, prospective, comparative, blinded studies in the literature on diagnostic imaging of cervical spondylotic myelopathy. The conclusion of the other low-evidence studies on the imaging diagnostic work-up of cervical spondylotic disease can be drawn as follows: there are difficulties in establishing a gold standard for the diagnosis of CSM. Neuroimaging techniques are characterised by their high sensitivity and low specificity, so these methods should be used early in the process of making a diagnosis of CSM. CT-myelografie is better than MRI (including newer MRI techniques) in the diagnosis of spondylotic cervical radiculopathy, as there is some evidence that the degree of cervical stenosis may be underestimated when MR is used. However, MR is the method of choice for assessment of intrinsic spinal cord disorders. There is no imaging method which may be considered to be a definite diagnostic marker, so the degree of diagnostic certainty depends on the combination of investigations and their agreement with the clinical history and examination. When chronic spondylotic myelopathy is clinically the most likely cause of the patients symptoms and signs, the following recommendations can be derived from the literature for diagnostic imaging of the cervical spine. MRI is the study of first choice for the pre- and postoperative evaluation of CSM. When specific questions have to be answered before surgical intervention or when MRI is not available or cannot be performed because of specific reasons, or after surgery with metallic implants, Myelography and/or CT-myelography may be useful for a quantitative analysis of narrowing of the spinal canal and compression and deformity of the cord or for functional studies.
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