Predictors of symptomatic myelopathy in degenerative cervical spinal cord compression

Abstract

ObjectivesTo update a previously established list of predictors for neurological cervical cord dysfunction in nonmyelopathic degenerative cervical cord compression (NMDCCC).Material and MethodsA 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.ResultsClinical 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.ConclusionsIn 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.

Recovery priorities in degenerative cervical myelopathy: a cross-sectional survey of an international, online community of patients

“…Degenerative cervical myelopathy (DCM) has been coined as an umbrella term for degenerative and congenital or acquired conditions of the cervical spine, such as spondylosis or ossification of the posterior longitudinal ligament, which lead to symptomatic cord compression 1. With an estimated prevalence of up to 5% in individuals above 40 years old,2 3 DCM is the most common cause of spinal cord dysfunction worldwide 1. Given its degenerative aetiology and the rising age of the population, this incidence is expected to rise 4…”

HARDI-ZOOMit protocol improves specificity to microstructural changes in presymptomatic myelopathy

“…For dMRI analysis, the region of interest (ROI) was reduced to the C3-C6 vertebral levels due to the presence of artifacts at C7 level as described above. Clinical relevance should not be affected much since the expected C7 SC compression in DCM 34 is presented only in 8-11% of cases in the used Caucasian middle-Europe population 21,35 . If the NMDCCC causes more extensive changes even above the affected C7 segment, C3-C6 ROI might still work fine.…”

“…Second, the time course and reversibility of microstructural dMRI-detected SC changes in the compressed SC and their correlation with similar "functional" and possibly "biochemical" changes detected in NMDCCC using evoked potentials and magnetic resonance spectroscopycite 45,46 may further describe the DCM pathophysiology and lead to the optimization of the DCM diagnosis. Finally, these changes may help to identify NMDCCC subjects with higher risk of developing DCM (i.e., "presymptomatic myelopathy"), in addition to already demonstrated predictors 35,45 .…”

Is microdiffusion imaging able to improve the detection of cervical myelopathy? Study protocol of a prospective observational trial (MIDICAM-Trial)

“…The whole cervical spinal cord is segmented by an automatic algorithm on the T2w images from C2 to C7 (figure 2). The spinal canal diameter in the sagittal and reconstructed transverse T2w images at the maximal compressed segment and at the surrounding unaffected areas cranial and caudal of the stenosis is measured 31. The isolated area of the spinal cord is separated similarly (figure 2).…”

“…The isolated area of the spinal cord is separated similarly (figure 2). The compression ratios for spinal cord and canal are calculated according to Kadanka et al 31. We generate absolute value curves for the whole depicted cervical spine for every acquired parameter like shown in figure 2 (E+F) and figure 3.…”