Predictive effect of cervical spinal cord compression and corresponding segmental paravertebral muscle degeneration on the severity of symptoms in patients with cervical spondylotic myelopathy

• Published in: The spine journal 2021-07, Vol.21 (7), p.1099-1109
• Main Authors: Lin, Taotao, Wang, Zhenyu, Chen, Gang, Liu, Wenge
• Format: Article
• Language: English
• Subjects: Cervical sagittal parameters; Cervical spinal cord compression; Cervical spondylotic myelopathy; Modified Japanese Orthopedic Association(mJOA); Paravertebral muscle degeneration; Visual Analog Scale(VAS)
• ISSN: 1529-9430; 1878-1632
• DOI: 10.1016/j.spinee.2021.03.030

•This study is the first to investigate the degree of cervical spinal cord compression, the corresponding segmental paravertebral muscle degeneration, and cervical sagittal parameters in patients with cervical spondylotic myelopathy to predict the severity of the disease.•We found that in patients with cervical spondylotic myelopathy, corresponding segmental paravertebral muscle degeneration has relevance to neck pain, but it does not relate to limb weakness, neurological dysfunction, gait impairment, sensation or bladder/bowel function dysfunction. Cervical spinal cord compression is the only independent risk factor; when the degree of spinal cord compression exceeds 30%, the clinical symptoms are more severe.•Therefore, in clinical practice, we have to recognize that pain is an important outcome, so it should not be dismissed, but for patients whose main symptoms are other disabilities, the degree of paravertebral muscle degeneration should not be placed in too important position. Previous studies have found that cervical sagittal parameters and spinal cord compression are important risk factors for cervical spondylotic myelopathy (CSM). An increasing number of scholars believe that cervical muscle condition is also one of the factors affecting the severity of symptoms in affected patients. To determine whether: the degree of corresponding segmental paravertebral muscle degeneration is related to the severity of symptoms in patients with CSM; the degree of cervical spinal cord compression can predict the severity of symptoms in patients with CSM. A retrospective study. From January 2015 to January 2019, 121 patients with CSM were enrolled. The visual analog scale (VAS), neck disability index (NDI) and modified Japanese Orthopedic Association (mJOA) were used to assess cervical spinal function and quality of life. From January 2015 to January 2019, 121 patients with CSM were enrolled. The inclusion criterion was the presence of complete cervical lateral radiography and magnetic resonance imaging (MRI) data. The following radiographic parameters were measured: (1) C0-C2 Cobb angle; (2) C2-C7 Cobb angle (CL); (3) T1 slope (T1S); (4) neck tilt (NT); (5) C2-C7 sagittal vertical axis (SVA); and (6) T1S-CL. The following MRI parameters were measured: (1) up(low)-fat/muscle; (2) up(low)-fat/centrum; (3) up(low)-muscle/centrum; (4) cervical cord compression index (CCI); (5) S-index; and (6) cervical spinal cord compression area ratio (S0/S1). The VAS, NDI and mJO