Are subjects with spondylotic cervical cord encroachment at increased risk of cervical spinal cord injury after minor trauma?

Bednařík, Josef; Sládková, Dagmar; Kadaňka, Zdeněk; Dušek, Ladislav; Keřkovský, Miloš; Voháňka, Stanislav; Novotný, Oldřich; Urbánek, Igor; Němec, Martin

doi:10.1136/jnnp.2009.198945

Cited by 31 publications

(12 citation statements)

References 14 publications

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“…Bednařík et al reviewed their prospective cohort of 199 patients to specifically assess whether trauma is a risk factor for the development of neurological impairment. 12 They identified 14 traumatic episodes over the mean follow-up period of 44 months and reported one case where myelopathy manifested after the trauma. They concluded that the risk of spinal cord injury is probably low in individuals with asymptomatic cervical compression, especially if a restriction in risky activities is implemented.…”

Section: Asymptomatic Cervical Spinal Cord Compressionmentioning

confidence: 99%

Clinico-Radiographic Discordance: An Evidence-Based Commentary on the Management of Degenerative Cervical Spinal Cord Compression in the Absence of Symptoms or With Only Mild Symptoms of Myelopathy

Witiw

Mathieu

Nouri

et al. 2017

Global Spine Journal

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Study Design:Narrative review with commentary.Objectives:The growing use of magnetic resonance imaging (MRI) often leaves clinicians faced with scenarios where imaging findings are inconsistent with the clinical picture. This is particularly relevant for degenerative cervical spinal cord compression (CSCC). In this article, we provide a focused narrative literature review to address whether (1) surgery should be offered to asymptomatic patients with CSCC and (2) should MRI spinal cord signal changes influence clinical decisions for a patient with mild myelopathy from CSCC?Methods:Illustrative cases are presented with expert commentary which is supplemented by a focused literature review.Results:The literature suggests that CSCC from degenerative pathology is a common incidental radiographic finding. For those without symptoms of myelopathy, the short-term risk of progression is low. There is a lack of evidence to support surgery for asymptomatic individuals with CSCC who have no risk factors for progression. For these patients, the authors suggest non-operative management that includes education on the symptoms of myelopathy, clinical follow-up within 6 to 12 months, and avoidance of high-risk activities. Conversely, symptomatic patients have a notable risk of progression. Surgical intervention improves neurological function and quality of life regardless of severity. The authors support surgery as an option for all patients with mild myelopathy who are appropriate operative candidates. Intramedullary signal change on MRI has not been shown to reliably predict progression.Conclusions:While MRI technologies are under evolution, we advise that surgical decisions for patients with CSCC should rely on clinical assessment and not imaging findings.

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Section: Asymptomatic Cervical Spinal Cord Compressionmentioning

confidence: 99%

Clinico-Radiographic Discordance: An Evidence-Based Commentary on the Management of Degenerative Cervical Spinal Cord Compression in the Absence of Symptoms or With Only Mild Symptoms of Myelopathy

Witiw

Mathieu

Nouri

et al. 2017

Global Spine Journal

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“… 22 , 5 , 23 The rate of hospitalization of SCI in patients with myelopathy from OPLL was significantly higher than the rate observed in a healthy population (hazard ratio of 32.2). 5 Contrary to these findings, a prospective study by Bednarik, Sladkova 66 did not show a relationship between traumatic events and myelopathy onset in 199 patients with initial asymptomatic spinal cord compression. During the study, 14 patients experienced traumatic events at an average of 44-months follow-up, but none were associated with immediate neurological deterioration.…”

Section: Introductionmentioning

confidence: 83%

Degenerative Cervical Myelopathy: Development and Natural History [AO Spine RECODE-DCM Research Priority Number 2]

Nouri

Tessitore

Molliqaj

et al. 2022

Global Spine Journal

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Study Design: Narrative review. Objectives: To discuss the current understanding of the natural history of degenerative cervical myelopathy (DCM). Methods: Literature review summarizing current evidence pertaining to the natural history and risk factors of DCM. Results: DCM is a common condition in which progressive arthritic disease of the cervical spine leads to spinal cord compression resulting in a constellation of neurological symptoms, in particular upper extremity dysfunction and gait impairment. Anatomical factors including cord-canal mismatch, congenitally fused vertebrae and genetic factors may increase individuals’ risk for DCM development. Non-myelopathic spinal cord compression (NMSCC) is a common phenomenon with a prevalence of 24.2% in the healthy population, and 35.3% among individuals >60 years of age. Clinical radiculopathy and/or electrophysiological signs of cervical cord dysfunction appear to be risk factors for myelopathy development. Radiological progression of incidental Ossification of the Posterior Longitudinal Ligament (OPLL) is estimated at 18.3% over 81-months and development of myelopathy ranges between 0-61.5% (follow-up ranging from 40 to 124 months between studies) among studies. In patients with symptomatic DCM undergoing non-operative treatment, 20-62% will experience neurological deterioration within 3-6 years. Conclusion: Current estimates surrounding the natural history of DCM, particularly those individuals with mild or minimal impairment, lack precision. Clear predictors of clinical deterioration for those treated with non-operative care are yet to be identified. Future studies are needed on this topic to help improve treatment counseling and clinical prognostication.

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“…Unfortunately, despite the lack of any study showing a benefit of a prophylactic surgical decompression in NMDCC, some spondylosurgeons recommend and perform such intervention. Recommendations based on expert opinion and longitudinal studies on natural course of NMDCC and risk factors for progression to DCM [12,22,33] generally recommend consideration of surgical treatment in those patients who present with clinical or electrophysiological evidence of cervical radicular dysfunction or central conduction deficits disclosed by electrophysiological examination and are thus at higher risk for developing myelopathy [34,35]. There is also no clear agreement on the conservative treatment of both NMDCC and mild DCM patients.…”

Section: Discussionmentioning

confidence: 99%

Walk and Run Test in Patients with Degenerative Compression of the Cervical Spinal Cord

Kadaňka

Skutil

Vlčková

et al. 2021

JCM

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Impaired gait is one of the cardinal symptoms of degenerative cervical myelopathy (DCM) and frequently its initial presentation. Quantitative gait analysis is therefore a promising objective tool in the disclosure of early cervical cord impairment in patients with degenerative cervical compression. The aim of this cross-sectional observational cohort study was to verify whether an objective and easily-used walk and run test is capable of detecting early gait impairment in a practical proportion of non-myelopathic degenerative cervical cord compression (NMDCC) patients and of revealing any correlation with severity of disability in DCM. The study group consisted of 45 DCM patients (median age 58 years), 126 NMDCC subjects (59 years), and 100 healthy controls (HC) (55.5 years), all of whom performed a standardized 10-m walk and run test. Walking/running time/velocity, number of steps and cadence of walking/running were recorded; analysis disclosed abnormalities in 66.7% of NMDCC subjects. The DCM group exhibited significantly more pronounced abnormalities in all walk/run parameters when compared with the NMDCC group. These were apparent in 84.4% of the DCM group and correlated closely with disability as quantified by the modified Japanese Orthopaedic Association scale. A standardized 10-m walk/run test has the capacity to disclose locomotion abnormalities in NMDCC subjects who lack other clear myelopathic signs and may provide a means of classifying DCM patients according to their degree of disability.

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Are subjects with spondylotic cervical cord encroachment at increased risk of cervical spinal cord injury after minor trauma?

Cited by 31 publications

References 14 publications

Clinico-Radiographic Discordance: An Evidence-Based Commentary on the Management of Degenerative Cervical Spinal Cord Compression in the Absence of Symptoms or With Only Mild Symptoms of Myelopathy

Clinico-Radiographic Discordance: An Evidence-Based Commentary on the Management of Degenerative Cervical Spinal Cord Compression in the Absence of Symptoms or With Only Mild Symptoms of Myelopathy

Degenerative Cervical Myelopathy: Development and Natural History [AO Spine RECODE-DCM Research Priority Number 2]

Walk and Run Test in Patients with Degenerative Compression of the Cervical Spinal Cord

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