Predictors of symptomatic myelopathy in degenerative cervical spinal cord compression

• Published in: Brain and behavior 2017-09, Vol.7 (9), p.e00797-n/a
• Main Authors: Kadanka, Zdenek, Adamova, Blanka, Kerkovsky, Milos, Dusek, Ladislav, Jurova, Barbora, Vlckova, Eva, Bednarik, Josef
• Format: Article
• Language: English
• Subjects: Adult; Aged; cervical radiculopathy; Cervical Vertebrae - diagnostic imaging; Cervical Vertebrae - physiopathology; degenerative cervical myelopathy; Diffusion Tensor Imaging; Disease Progression; Female; Follow-Up Studies; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Multivariate analysis; nonmyelopathic degenerative cervical cord compression; Original Research; Physical Examination; predictive model; Prospective Studies; Spinal Cord Compression - diagnosis; Spinal Cord Compression - diagnostic imaging; Spinal Cord Compression - physiopathology; Spinal Cord Diseases - diagnosis; Spinal Cord Diseases - diagnostic imaging; Spinal Cord Diseases - physiopathology
• ISSN: 2162-3279; 2162-3279
• DOI: 10.1002/brb3.797

Objectives To update a previously established list of predictors for neurological cervical cord dysfunction in nonmyelopathic degenerative cervical cord compression (NMDCCC). Material and Methods A 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. Results Clinical 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. Conclusions In 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. A prospective observational follow‐up study was performed in a cohort of 112 consecutive nonmyelopathic degenerative cervical cord compression 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). Radiculopathy, cross‐sectional spinal cord area