Cervical myelopathy: a clinical and radiographic evaluation and correlation to cervical spondylotic myelopathy.
METHODS
Retrospective analysis of a cohort of patients treated between April 2006 and January 2008, and diagnosed with cervical degenerative disease.


OBJECTIVE
To determine the correlation of the clinical findings associated with cervical myelopathy to the presence of spinal cord compression or cord signal abnormalities on magnetic resonance imaging (MRI).


BACKGROUND
There are numerous reports describing the radiographic features of cervical spondylosis, however, no publication specifically describes the association between the physical signs of cervical myelopathy and the presenting imaging findings.


METHODS
Myelopathy was defined as the presence of greater than one long-tract sign localized to the cervical spinal cord (Hoffman or Babinski signs, clonus, hyper-reflexia, crossed abductor sign, and/or gait dysfunction) on physical examination in the absence of other neurologic condition(s). The presence of these signs, MRI imaging features of spinal cord compression and hyperintense T2 intraparenchymal cord signal abnormality, and patient demographics were recorded.


RESULTS
One hundred three patients met inclusion criteria (age >18, symptomatic cervical degenerative disease and complete neurologic assessment). Of these, 54 had clinical findings of cervical myelopathy. Radiographic features of cord compression were present in 62% of patients, and 84% had myelopathy on examination. No patients without cord compression presented with myelopathy (P < 0.0001). Thirty-five percent of the patients presented with hyperintense signal on T2 MRI within the spinal cord parenchyma. This finding correlated with the presence of myelopathy (P < 0.0001). Multivariate analysis on the subset with cord compression indicates that the likelihood of myelopathy increased with the presence of cord signal hyperintensity (odds ratio [OR], 11.4), sensory loss (OR, 16.9), and age (OR, 1.10 per year).


CONCLUSIONS
The diagnosis of cervical myelopathy is based on presenting symptoms and physical examination. This analysis illustrates that radiographic cervical spinal cord compression and hyperintense T2 intraparen chymal signal abnormalities correlate with the presence of myelopathic findings on physical examination.
From the Departments of *Neurological Surgery and †Orthopedic Surgery, Jefferson Medical College, Philadelphia, PA.
James S
JS
Harrop
Swetha
S
Naroji
Mitchell
M
Maltenfort
D Greg
DG
Anderson
Todd
T
Albert
John K
JK
Ratliff
Ravi K
RK
Ponnappan
Jeffery A
JA
Rihn
Harvey E
HE
Smith
Alan
A
Hilibrand
Ashwini D
AD
Sharan
Alexander
A
Vaccaro
D000328:Adult; D000368:Aged; D002574:Cervical Vertebrae / Q000000981:diagnostic imaging / Q000473:pathology; D005260:Female; D006801:Humans; D016015:Logistic Models; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011859:Radiography; D012189:Retrospective Studies; D013117:Spinal Cord Compression / Q000175:diagnosis* / Q000000981:diagnostic imaging; D013118:Spinal Cord Diseases / Q000175:diagnosis* / Q000000981:diagnostic imaging; D055009:Spondylosis / Q000175:diagnosis* / Q000000981:diagnostic imaging