The Frequency of Various “Myelopathic Symptoms” in Cervical Myelopathy

Abstract

Study Design: A retrospective cohort of prospective data. Objective: Determine the frequency of various symptoms in a surgical cohort of cervical myelopathy (CM). Summary of Background Data: CM can be difficult to diagnose as there is no sine qua non “myelopathic symptom.” Despite extensive literature, the likelihood or frequency of symptoms at presentation remains unclear. Materials and Methods: A total of 484 patients treated at a single academic center were reviewed. Preoperative symptoms included: axial neck pain; upper extremity (UE) pain; UE sensory or motor deficit; lower extremity (LE) sensory or motor deficit; and sphincter dysfunction. It was noted whether a symptom was the chief complaint (CC) and/or one of a list of overall symptoms (OS) reported by the patient. Magnetic resonance imaging was assessed for the maximal cord compression level and T2 hyperintensity. Results: The most common CC was UE sensory deficit (46.5%), whereas the most common OS were UE and LE motor deficits (82.6% and 81.2%). Neck pain was significantly less common (32.6% CC, 55.4% OS), and sphincter dysfunction was rare (0.6% CC, 16.5% OS). UE pain as a CC was significantly higher when the maximal compression involved a more distal level. The presence of T2 hyperintensity was negatively associated with neck pain but positively associated with sensory and motor deficits of LE. Conclusions: The most common CC in CM related to UE sensation, whereas the most common OS related to upper and lower motor function. UE pain was more common with more distal cord compression. Those with T2 hyperintensity had worse myelopathy and were less likely to have neck pain, but more likely to have LE symptoms. To our knowledge, this study is the largest to quantify the frequency of myelopathic symptom presentation in a surgical population. These findings provide valuable insight into the symptomatic presentation of CM in clinical practice and can be used to better inform diagnosis and treatment in this complex patient population. Level of Evidence: Level II—retrospective study.

Post-operative neurological improvement is associated with significant neck pain attenuation after surgery for cervical ossification of the posterior longitudinal ligament: a prospective multicenter registry study

“…Segmental spinal cord compression can cause local impairment of the spinothalamic tract at its chiasma at the central grey matter of the spinal cord [20]. Irrespective of the precise cause, a large-scale cohort study revealed that cervical myelopathy can cause neck pain [21].…”

Neurological improvement is associated with neck pain attenuation after surgery for cervical ossification of the posterior longitudinal ligament

“…Segmental spinal cord compression can cause local impairment of the spinothalamic tract at its chiasma at the central grey matter of the spinal cord 21 . Irrespective of the precise cause, a large-scale cohort study revealed that cervical myelopathy can cause neck pain 22 .…”

The Frequency of Symptoms in Patients With a Diagnosis of Degenerative Cervical Myelopathy: Results of a Scoping Review

“…Across several studies, the sensitivities of bladder dysfunction for diagnosis DCM ranged from 4% to 68% with a weighted average of 38% (95% CI 34%-43%). Other studies did not distinguish between bladder and bowel dysfunction and either reported the frequency of sphincter disturbance (7%-100%) 21,40,48,50,54,57,59 or of bladder and/or bowel dysfunction (5%-30%). 20,26,38,39,42,43,61,62,71 Three studies reported the frequency of sexual dysfunction in a cohort of DCM patients.…”

“…30,31,71 Symptoms Related to Pain. Several studies reported on the frequency of various types of pain in patients with DCM: radicular or radiating (n = 12), 20,24,25,31,34,48,49,59,61,66,67,75 neck and/or shoulder (n = 27), 20,23,25,28,[30][31][32][34][35][36]42,46,47,49,[51][52][53][54]56,57,61,64,65,67,71,73,74 upper extremity (n = 5), 26,36,52,57,65 axial (n = 5), 27,40,44,65,72 back (n = 2) ...…”

“…Finally, rates of any lower extremity sensory symptom were lower than rates of any upper sensory symptom and ranged from 17% to 40% (weighted average: 25%, 95% CI 22%-29%). 26,39,47,57 Based on two studies, a minority of patients complained of great toe (4%) and trunk numbness (4%-5%). 30,71 Rates of zonesthesia (ie band-like sensation at chest or trunk) ranged from 20% to 100% across three studies.…”