title: Management of asymptomatic cervical spinal stenosis in the setting of symptomatic tandem lumbar stenosis: a review.
abstract: BACKGROUND
  This article reviews the literature regarding tandem asymptomatic cervical stenosis in the setting of symptomatic lumbar stenosis. The presenting features of cervical spondylotic myelopathy are insidious and consistent with upper motor neuron loss. Often, asymptomatic cervical stenosis is encountered in the clinical setting during the workup of a symptomatic lumbar stenosis and degenerative disease.
  
  
  METHODS
  A PubMed (1966 to July 2013) electronic database search was conducted for articles pertaining to the diagnosis of incidentally discovered cervical cord compression. Keywords and MESH terms were limited to asymptomatic cervical stenosis, asymptomatic cervical compression, asymptomatic spinal stenosis, asymptomatic cervical spondylosis, and asymptomatic cervical cord signal. The primary literature topics for manuscript inclusion were the development of symptomatic myelopathy from asymptomatic cord signal edema, as well as the presence of tandem stenosis as defined above by incidental cervical stenosis during the workup of lumbar degenerative disease.
  
  
  RESULTS
  There were no previous systematic reviews, randomized trials, or prospective studies on the management of tandem cervical and thoracic stenosis. Five studies, all retrospective reviews containing relevant data were included in the review. Asymptomatic cervical stenosis encountered in the investigation of lumbar symptoms was had a 23% incidence. A risk of 5% per year of development of myelopathy previously reported.
  
  
  CONCLUSIONS
  There is insufficient evidence in the literature to support the need for preemptive decompression for asymptomatic cervical cord compression with or without a correlative T2 hyperintense cord signal. Early diagnosis of radiculopathy or myelopathy in patients with cervical stenosis (i.e., through conversion of asymptomatic to symptomatic state) is important as each patient with in this clinical setting should be followed closely, as the literature shows the tendency for a clinical progression to eventual cervical myelopathy.
authors.affiliation: Department of Neurological Surgery, Thomas Jefferson University Hospital, 909 Walnut St., 3rd floor, Philadelphia 19107, USA. Electronic address: georgeghobrial@gmail.com.
authors.forename: George M
authors.initials: GM
authors.lastname: Ghobrial
authors.affiliation: Department of Neurological Surgery, Thomas Jefferson University Hospital, 909 Walnut St., 3rd floor, Philadelphia 19107, USA; Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix 85003, USA.
authors.forename: Mark E
authors.initials: ME
authors.lastname: Oppenlander
authors.affiliation: Department of Neurological Surgery, Thomas Jefferson University Hospital, 909 Walnut St., 3rd floor, Philadelphia 19107, USA.
authors.forename: Christopher M
authors.initials: CM
authors.lastname: Maulucci
authors.affiliation: Department of Neurological Surgery, Thomas Jefferson University Hospital, 909 Walnut St., 3rd floor, Philadelphia 19107, USA.
authors.forename: Matthew
authors.initials: M
authors.lastname: Viereck
authors.affiliation: Department of Neurological Surgery, Thomas Jefferson University Hospital, 909 Walnut St., 3rd floor, Philadelphia 19107, USA.
authors.forename: Srinivas
authors.initials: S
authors.lastname: Prasad
authors.affiliation: Department of Neurological Surgery, Thomas Jefferson University Hospital, 909 Walnut St., 3rd floor, Philadelphia 19107, USA.
authors.forename: Ashwini D
authors.initials: AD
authors.lastname: Sharan
authors.affiliation: Department of Neurological Surgery, Thomas Jefferson University Hospital, 909 Walnut St., 3rd floor, Philadelphia 19107, USA.
authors.forename: James S
authors.initials: JS
authors.lastname: Harrop
mesh_terms: D002574:Cervical Vertebrae / Q000473:pathology*; D006801:Humans; D033162:Incidental Findings; D008159:Lumbar Vertebrae / Q000473:pathology*; D013130:Spinal Stenosis / Q000175:diagnosis / Q000628:therapy*
keywords: Asymptomatic stenosis; Myelopathy; Spondylosis