Current management of patients with degenerative cervical spine compression
Authors:
Z. Kadaňka Jr.; T. Horák; J. Bednařík
Authors‘ workplace:
Neurologická klinika LF MU a FN Brno
Published in:
Cesk Slov Neurol N 2019; 82(6): 632-636
Category:
Review Article
doi:
https://doi.org/10.14735/amcsnn2019632
Overview
Degenerative cervical myelopathy (DCM) is the most serious consequence of cervical spinal stenosis (CS) and degenerative cervical spinal cord compression. The spinal cord, however, is quite resistant especially to gradual, chronic mechanical compression. Asymptomatic degenerative cervical cord compression (ADCCC), which is characterized by cervical cord compression in medical imaging techniques, but without clinical signs of myelopathy, is therefore very common. In patients with moderate and severe DCM, surgical intervention is strongly recommended. However, in patients with mild DCM and ADCCC, there is no clear, evidence-based agreement on the management and treatment algorithm. Currently, a lot of predictors of ADCC progression to symptomatic DCM have been identified and this has led some surgeons to recommend early decompression surgery in these high-risk patients. However, further studies are required to refine our understanding of the importance of these predictors. Moreover, there are some methodological and ethical challenges that make multicentre randomized study in ADCCC and mild DCM patients difficult to realize.
The authors declare they have no potential conflicts of interest concerning drugs, products, or services used in the study.
The Editorial Board declares that the manuscript met the ICMJE “uniform requirements” for biomedical papers.
Keywords:
degenerative cervical myelopathy – asymptomatic degenerative cervical cord compression – spinal cervical stenosis
Sources
1. Montgomery DM, Brower RS. Cervical spondylotic myelopathy. Clinical syndrome and natural history. Orthop Clin North Am 1992; 23(3): 487– 493.
2. Teresi LM, Lufkin RB, Reicher MA et al. Asymptomatic degenerative disk disease and spondylosis of the cervical spine: MR imaging. Radiology 1987; 164(1): 83– 88. doi: 10.1148/ radiology.164.1.3588931.
3. Kovalova I, Kerkovsky M, Kadanka Z et al. Prevalence and imaging characteristics of nonmyelopathic and myelopathic spondylotic cervical cord compression. Spine (Phila Pa 1976) 2016; 41(24): 1908– 1916. doi: 10.1097/ BRS.0000000000001842.
4. Adamova B, Bednarik J, Andrasinova T et al. Does lumbar spinal stenosis increase the risk of spondylotic cervical spinal cord compression? Eur Spine J 2015; 24(12): 2946– 2953. doi: 10.1007/ s00586-015-4049-0.
5. Shamji MF, Ames CP, Smith JS et al. Myelopathy and spinal deformity: relevance of spinal alignment in planning surgical intervention for degenerative cervical myelopathy. Spine (phila Pa 1976) 2013; 38 (22 Suppl 1): S147– S148. doi: 10.1097/ BRS.0b013e3182a7f521.
6. Karadimas SK, Gatzounis G, Fehlings MG. Pathobiology of cervical spondylotic myelopathy. Eur Spine J 2015; 24 (Suppl 2): 132– 138. doi: 10.1007/ s00586-014-3264-4.
7. Tracy JA, Bartleson JD. Cervical spondylotic myelopathy. Neurologist 2010; 16(3): 176– 187. doi: 10.1097/ NRL.0b013e3181da3a29.
8. Kalsi-Ryan S, Karadimas SK, Fehlings MG. Cervical spondylotic myelopathy: the clinical phenomenon and the current pathobiology of an increasingly prevalent and devastating disorder. Neuroscientist 2013; 19(4): 409– 421. doi: 10.1177/ 1073858412467377.
9. Fehlings MG, Tetreault LA, Riew KD et al. A Clinical practice guideline for the management of patients with degenerative cervical myelopathy: recommendations for patients with mild, moderate, and severe disease and nonmyelopathic patients with evidence of cord compression. Global Spine J 2017; 7 (3 Suppl): 70S– 83S. doi: 10.1177/ 2192568217701914.
10. Benzel EC, Lancon J, Kesterson L et al. Cervical laminectomy and dentate ligament section for cervical spondylotic myelopathy. J Spinal Disord 1991; 4(3): 286– 295.
11. Vitzthum HE, Dalitz K. Analysis of five specific scores for cervical spondylogenic myelopathy. Eur Spine J 2007; 16(12): 2096– 2103. doi: 10.1007/ s00586-007-0512-x.
12. Clarke E, Robinson PK. Cervical myelopathy: a complication of cervical spondylosis. Brain 1956; 79(3): 483– 510. doi: 10.1093/ brain/ 79.3.483.
13. Kadaňka Z. Spondylogenní cervikální myelopatie. Cesk Slov Neurol N 2010; 73/ 106(3): 209– 226.
14. Wilson JR, Barry S, Fischer DJ et al. Frequency, timing, and predictors of neurological dysfunction in the nonmyelopathic patient with cervical spinal cord compression, canal stenosis, and/ or ossification of the posterior longitudinal ligament. Spine (Phila Pa 1976) 2013; 38 (22 Suppl 1): S37– S54. doi: 10.1097/ BRS.0b013e3182a7f2e7.
15. Bednarik J, Kadanka Z, Dusek L et al. Presymptomatic spondylotic cervical myelopathy: an updated predictive model. Eur Spine J 2008; 17(3): 421– 431. doi: 10.1007/ s00586-008-0585-1.
16. Bednařík J, Sládková D, Kadaňka Z et al. Are subjects with spondylotic cervical cord encroachment at increased risk of cervical spinal cord injury after minor trauma? J Neurol Neurosurg Psychiatry 2011; 82(7): 779– 781. doi: 10.1136/ jnnp.2009.198945.
17. Keřkovský M, Bednařík J, Dušek L et al. Magnetic resonance diffusion tensor imaging in patients with cervical spondylotic spinal cord compression: correlations between clinical and electrophysiological findings. Spine (Phila Pa 1976) 2012; 37(1): 48– 56. doi: 10.1097/ BRS.0b013e31820e6c35.
18. Keřkovský M, Bednařík J, Jurová B et al. Spinal cord MR diffusion properties in patients with degenerative cervical cord compression. J Neuroimaging 2017; 27(1): 149– 157. doi: 10.1111/ jon.12372.
19. Kadanka Z, Adamova B, Kerkovsky M et al. Predictors of symptomatic myelopathy in degenerative cervical spinal cord compression. Brain Behav 2017; 7(9): e00797. doi: 10.1002/ brb3.797.
20. Emery SE. Cervical spondylotic myelopathy: diagnosis and treatment. J Am Acad Orthop Surg 2001; 9(6): 376– 388.
21. Shedid D, Benzel EC. Cervical spondylosis anato-my: pathophysiology and biomechanics. Neurosurgery 2007; 60 (1 Suppl 1): S7– S13. doi: 10.1227/ 01.NEU.0000215430.86569.C4.
22. Epstein NE. Laminectomy for cervical myelopathy. Spinal Cord 2003; 41(6): 317– 327. doi: 10.1038/ sj.sc.3101477.
23. Murphy DR, Coulis CM, Gerrard JK. Cervical spondylosis with spinal cord encroachment: should preventive surgery be recommended? Chiropr Osteopat 2009; 17: 8. doi: 10.1186/ 1746-1340-17-8.
24. Gibson J, Nouri A, Krueger B et al. Degenerative cervical myelopathy: a clinical review. Yale J Biol Med 2018; 91(1): 43– 48.
25. Zhang RJ, Shen CL, Zhang JX et al. Clinical features and surgical outcomes of cervical spondylotic myelopathy in patients of different ages: a retrospective study. Spinal Cord 2018; 56(1): 7– 13. doi: 10.1038/ sc.2017.91.
26. Tetreault L, Ibrahim A, Côté P et al. A systematic review of clinical and surgical predictors of complications following surgery for degenerative cervical myelopathy. J Neurosurg Spine 2016; 24(1): 77– 99. doi: 10.3171/ 2015.3.SPINE14971.
Labels
Paediatric neurology Neurosurgery NeurologyArticle was published in
Czech and Slovak Neurology and Neurosurgery
2019 Issue 6
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