Presymptomatic spondylotic cervical myelopathy: an updated predictive model.
Spondylotic cervical cord compression detected by imaging methods is a prerequisite for the clinical diagnosis of spondylotic cervical myelopathy (SCM). Little is known about the spontaneous course and prognosis of clinically "silent" presymptomatic spondylotic cervical cord compression (P-SCCC). The aim of the present study was to update a previously published model predictive for the development of clinically symptomatic SCM, and to assess the early and late risks of this event in a larger cohort of P-SCCC 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 2-12 years). Various demographic, clinical, imaging, and electrophysiological parameters were correlated with the time for the 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 symptomatic SCM developed within 12 months in 16 patients (35.5%). 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 (< or =12 months) of SCM, while MRI hyperintensity predicted later (>12 months) progression to symptomatic SCM. The multivariate predictive model based on these variables correctly predicted early progression into SCM in 81.4% of the 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 P-SCCC. Electrophysiological evaluation of cervical cord dysfunction in patients with cervical radiculopathy or back pain is valuable. Meticulous follow-up is justified in high-risk P-SCCC cases.
Bednarik
Josef
J
Department of Neurology, Faculty Hospital Brno and Medical Faculty of the Masaryk University, Jihlavská 20, 625 00, Brno, The Czech Republic. jbednar@fnbrno.cz.
Kadanka
Zdenek
Z
Department of Neurology, Faculty Hospital Brno and Medical Faculty of the Masaryk University, Jihlavská 20, 625 00, Brno, The Czech Republic.
Dusek
Ladislav
L
Institute of Biostatistics and Analyses, Masaryk University, Brno, The Czech Republic.
Kerkovsky
Milos
M
Department of Radiology, Faculty Hospital and Medical Faculty of the Masaryk University, Brno, The Czech Republic.
Vohanka
Stanislav
S
Department of Neurology, Faculty Hospital Brno and Medical Faculty of the Masaryk University, Jihlavská 20, 625 00, Brno, The Czech Republic.
Novotny
Oldrich
O
Department of Neurology, Faculty Hospital Brno and Medical Faculty of the Masaryk University, Jihlavská 20, 625 00, Brno, The Czech Republic.
Urbanek
Igor
I
Department of Neurology, Faculty Hospital Brno and Medical Faculty of the Masaryk University, Jihlavská 20, 625 00, Brno, The Czech Republic.
Kratochvilova
Dagmar
D
Department of Neurology, Faculty Hospital Brno and Medical Faculty of the Masaryk University, Jihlavská 20, 625 00, Brno, The Czech Republic.
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002574:Cervical Vertebrae / Q000473:pathology* / Q000503:physiopathology; D015331:Cohort Studies; D018450:Disease Progression; D004568:Electrodiagnosis / Q000379:methods; D005071:Evoked Potentials / Q000502:physiology; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D008959:Models, Neurological; D009434:Neural Pathways / Q000503:physiopathology; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D011843:Radiculopathy / Q000175:diagnosis* / Q000503:physiopathology; D013116:Spinal Cord / Q000503:physiopathology; D013117:Spinal Cord Compression / Q000175:diagnosis* / Q000503:physiopathology; D013128:Spinal Osteophytosis / Q000175:diagnosis* / Q000503:physiopathology