The Prevalence of Asymptomatic and Symptomatic Spinal Cord Compression on Magnetic Resonance Imaging: A Systematic Review and Meta-analysis

Abstract

Study Design: Systematic review and meta-analysis. Objectives: Cervical spinal cord compression (SCC) due to degenerative changes of the spine is a frequent finding on magnetic resonance imaging (MRI). While most people remain asymptomatic, a proportion develop symptoms of degenerative cervical myelopathy (DCM). DCM is an often-progressive neurological disease that can cause quadriplegia. The epidemiology of SCC and DCM is poorly understood. We sought to estimate the prevalence of degenerative cervical SCC and DCM from cross-sectional cohorts undergoing MRI. Methods: We conducted a systematic review and meta-analysis of MRI reports on human subjects older than 16 years with degenerative SCC. A predetermined search strategy was used to identify relevant literature on MEDLINE. Title and abstract screenings were followed by full text screening. Data was extracted and analyzed by fixed or random-effects models. Results: The present search returned 1506 publications. Following our exclusion criteria, 19 studies were included. Subgroup analysis of 3786 individuals estimated the prevalence of asymptomatic SCC in a healthy population as 24.2% with a significantly higher prevalence of SCC in older populations compared with younger populations and American/European populations compared with Asian populations. Subgroup analysis of 1202 individuals estimated the prevalence of DCM in a healthy population as 2.3%. Conclusions: We present the first estimates of the prevalence of asymptomatic SCC and DCM. Studies investigating the epidemiology of SCC are heterogeneous in methodology and results. These data indicate the need for more studies into the epidemiology of SCC and DCM performed with consistent methodologies.

The Relative Merits of Posterior Surgical Treatments for Multi-Level Degenerative Cervical Myelopathy Remain Uncertain: Findings from a Systematic Review

“…This results in functional impairment of the spinal cord that progresses at various rates and patterns, most commonly in a stepwise deterioration with periods of stable symptoms [1]. DCM is estimated to affect up to 2.3% [2] of adults and leads to progressive loss of dexterity, gait disturbance, imbalance, bladder disturbance, and occasionally incontinence and tetraplegia [1]. Surgery is currently the only treatment shown to alter the natural history of the disease: removing the mechanical compression on the spinal cord can stop disease progression and typically offer meaningful, albeit incomplete, recovery.…”

Walk and Run Test in Patients with Degenerative Compression of the Cervical Spinal Cord

“…Further, degenerative compression of the cervical cord may remain free of any of the symptoms or signs of DCM. This condition–known as “presymptomatic” or “non-myelopathic” degenerative cervical cord compression (NMDCC) is highly prevalent in those above 60 years of age, involving, on average, about 40% of this European/American subpopulation [ 10 , 11 ]. This lies in striking contrast to the prevalence of DCM, estimated at the far lower figure of 2.3% [ 10 ].…”

“…This condition–known as “presymptomatic” or “non-myelopathic” degenerative cervical cord compression (NMDCC) is highly prevalent in those above 60 years of age, involving, on average, about 40% of this European/American subpopulation [ 10 , 11 ]. This lies in striking contrast to the prevalence of DCM, estimated at the far lower figure of 2.3% [ 10 ]. Quantitative electrophysiological and MRI methods, however, serve to document functional or microstructural impairment in NMDCC patients, indicating that myelopathy precedes the occurrence of commonly detected clinical signs and symptoms.…”

The Role of Nutrition in Degenerative Cervical Myelopathy: A Systematic Review

“…Whilst approximately 1 in 5 adults without symptoms will have evidence of spinal cord compression on their MRI due to incidental degenerative changes in the spine, it is estimated only 10% will go on to develop DCM with time. 7 This indicates that the perception that DCM is driven uniquely by spinal cord compression is an over-simplification, 8 and additional, dynamic factors must contribute to the aetiology of DCM, and/or influence the vulnerability of the spinal cord. Early investigations have identified candidate genetic determinants in small series, 9 but environmental factors are also likely.…”