Are subjects with spondylotic cervical cord encroachment at increased risk of cervical spinal cord injury after minor trauma?
The aim of the study was to analyse the risk of symptomatic myelopathy after minor trauma in patients with asymptomatic spondylotic cervical spinal cord encroachment (ASCCE). In a cohort of 199 patients with ASCCE, previously followed prospectively in a study investigating progression into symptomatic myelopathy, the authors looked retrospectively for traumatic episodes that may have involved injury to the cervical spine. A questionnaire and data file analysis were employed to highlight whatever hypothetical relationship might emerge with the development of symptomatic myelopathy. Fourteen traumatic episodes in the course of a follow-up of 44 months (median) were recorded in our group (who had been instructed to avoid risky activities), with no significant association with the development of symptomatic myelopathy (found in 45 cases). Only three minor traumatic events without fracture of the cervical spine were found among the symptomatic myelopathy cases, with no chronological relationship between trauma and myelopathy. Furthermore, 56 traumatic spinal cord events were found before the diagnosis of cervical cord encroachment was established, with no correlation to either type of compression (discogenic vs osteophytic). In conclusion, the risk of spinal cord injury after minor trauma of the cervical spine in patients with ASCCE appeared to be low in our cohort provided risky activities in these individuals are restricted. Implementation of preventive surgical decompression surgery into clinical practice in these individuals should be postponed until better-designed studies provide proof enough for it to take precedence over a conservative approach.
Bednařík
Josef
J
Department of Neurology, Faculty Hospital and Masaryk University, Jihlavská 20, 625 00 Brno, Czech Republic. jbednar@fnbrno.cz
Sládková
Dagmar
D
Kadaňka
Zdeněk
Z
Dušek
Ladislav
L
Keřkovský
Miloš
M
Voháňka
Stanislav
S
Novotný
Oldřich
O
Urbánek
Igor
I
Němec
Martin
M
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D019299:Decompression, Surgical; D004185:Disability Evaluation; D004568:Electrodiagnosis; D005260:Female; D005500:Follow-Up Studies; D020233:Gait Disorders, Neurologic / Q000209:etiology; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D018908:Muscle Weakness / Q000209:etiology; D010146:Pain / Q000209:etiology; D010523:Peripheral Nervous System Diseases / Q000473:pathology; D012189:Retrospective Studies; D012306:Risk; D013119:Spinal Cord Injuries / Q000453:epidemiology*; D016103:Spinal Fractures / Q000453:epidemiology; D055009:Spondylosis / Q000150:complications* / Q000453:epidemiology; D014057:Tomography, X-Ray Computed; D014474:Unconsciousness / Q000150:complications