title: MRI Analysis of the Combined Prospectively Collected AOSpine North America and International Data: The Prevalence and Spectrum of Pathologies in a Global Cohort of Patients With Degenerative Cervical Myelopathy.
abstract: METHODS
  An ambispective analysis.
  
  
  OBJECTIVE
  The aim of this study was to report the global prevalence of specific degenerative cervical pathologies in patients with degenerative cervical myelopathy (DCM) through detailed review of magnetic resonance imaging (MRIs).
  
  
  BACKGROUND
  DCM encompasses a spectrum of age-related conditions that result in progressive spinal cord injury.
  
  
  METHODS
  MRIs of 458 patients (age 56.4 ± 11.8, 285 male, 173 female) were reviewed for specific degenerative features, directionality of cord compression, levels of spinal cord compression, and signal changes on sagittal T2-weighted imaging (T2WI) and sagittal T1-weighted imaging (T1WI). Data were analyzed for differences between sex using Chi-square tests and geographic variations using Kruskal-Wallis tests.
  
  
  RESULTS
  Spondylosis was frequently present (89.7%) and was commonly accompanied by enlargement of the ligamentum flavum (LF) (59.9%). Single-level disc pathology, ossification of posterior longitudinal ligament (OPLL), and spondylolisthesis had a prevalence of ∼10% each. OPLL was accompanied by spondylosis in 91.7%. Klippel-Feil syndrome was observed in 2.0%. The Asia-Pacific region had more OPLL (29%, P = 3 × 10) and less spondylolisthesis (1.9%, P = 0.002). Females presented more commonly with single-level disc pathology (13.9% vs. 6.7%; P = 0.013), and males with spondylosis (92.3% vs. 85.6%; P = 0.02) and enlargement of LF (61.4% vs. 49.1%; P = 0.01). C5 to C6 was the most frequent maximum compressed site (39.5%) and region for T2WI hyperintensity (38.9%). T2WI hyperintensity more commonly presented in males (82.4% vs. 66.7%; P < 0.001).
  
  
  CONCLUSIONS
  This is the largest report on the prevalence and spectrum of pathology in patients with DCM. Herein, it has been demonstrated that degenerative features are highly interrelated, that females presented with milder MRI evidence of DCM, and that variations exist in the prevalence of pathologies between geographical regions.
  
  
  METHODS
  2.
authors.affiliation: Division of Neurosurgery and Spine Program, University of Toronto, Toronto, Ontario, Canada.|Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada.
authors.forename: Aria
authors.initials: A
authors.lastname: Nouri
authors.affiliation: Division of Neurosurgery and Spine Program, University of Toronto, Toronto, Ontario, Canada.|Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada.
authors.forename: Allan R
authors.initials: AR
authors.lastname: Martin
authors.affiliation: Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada.
authors.forename: Lindsay
authors.initials: L
authors.lastname: Tetreault
authors.affiliation: Division of Neurosurgery and Spine Program, University of Toronto, Toronto, Ontario, Canada.|Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada.
authors.forename: Anick
authors.initials: A
authors.lastname: Nater
authors.affiliation: Division of Neurosurgery and Spine Program, University of Toronto, Toronto, Ontario, Canada.|Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada.
authors.forename: So
authors.initials: S
authors.lastname: Kato
authors.affiliation: Division of Neurosurgery and Spine Program, University of Toronto, Toronto, Ontario, Canada.|Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada.
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Nakashima
authors.affiliation: Division of Neurosurgery and Spine Program, University of Toronto, Toronto, Ontario, Canada.|Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada.
authors.forename: Narihito
authors.initials: N
authors.lastname: Nagoshi
authors.affiliation: Division of Neurosurgery and Spine Program, University of Toronto, Toronto, Ontario, Canada.|Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada.
authors.forename: Hamed
authors.initials: H
authors.lastname: Reihani-Kermani
authors.affiliation: Division of Neurosurgery and Spine Program, University of Toronto, Toronto, Ontario, Canada.|Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada.
authors.forename: Michael G
authors.initials: MG
authors.lastname: Fehlings
mesh_terms: D000328:Adult; D000368:Aged; D016208:Databases, Factual; D005260:Female; D014943:Global Health; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D013118:Spinal Cord Diseases / Q000000981:diagnostic imaging* / Q000453:epidemiology* / Q000209:etiology / Q000473:pathology; D013122:Spinal Diseases / Q000150:complications / Q000000981:diagnostic imaging* / Q000453:epidemiology* / Q000473:pathology