Publication details
Presymptomatic spondylotic cervical myelopathy. An updated predictive model
| Authors | |
|---|---|
| Year of publication | 2008 |
| Type | Article in Periodical |
| Magazine / Source | European Spine Journal |
| MU Faculty or unit | |
| Citation | |
| Field | Neurology, neurosurgery, neurosciences |
| Keywords | spondylotic cervical cord compression; evoked potentials; electromyography; cervical spondylotic myelopathy |
| Description | Spondylotic cervical cord compression detected by imaging methods is a prerequisite for the clinical diagnosis of spondylotic cervical myelopathy (SCM). Little is known about spontaneous course and prognosis of clinically silent presymptomatic spondylotic cervical cord compression (PSCCC). The aim of the present study was to update a previously published predictive model for the development of clinically symptomatic SCM, and to assess the early and late risks of this event in a larger cohort of PSCCC 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 to 12 years). Various demographic, clinical, imaging, and electrophysiological parameters were correlated with the time to 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 in 16 patients (35.5%) the symptomatic SCM developed within 12 months. 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 (less than 12 months) of SCM, while MRI hyperintensity predicted later (more than 12 months) progression to symptomatic SCM. The multivariate predictive model based on these variables correctly predicted early progression into SCM in 81.4% of 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 PSCCC. Electrophysiological evaluation of cervical cord dysfunction in patients with cervical radiculopathy or back pain is valuable. In high risk PSCCC cases, meticulous follow up is justified. |
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