Bednarik Josef, Kadanka Zdenek, Dusek Ladislav, Kerkovsky Milos, Vohanka Stanislav, Novotny Oldrich, Urbanek Igor, Kratochvilova Dagmar
Department of Neurology, Faculty Hospital Brno and Medical Faculty of the Masaryk University, Jihlavská 20, 625 00, Brno, The Czech Republic.
Institute of Biostatistics and Analyses, Masaryk University, Brno, The Czech Republic.
Eur Spine J. 2008 Mar;17(3):421-431. doi: 10.1007/s00586-008-0585-1. Epub 2008 Jan 12.
Spondylotic cervical cord compression detected by imaging methods is a prerequisite for the clinical diagnosis of spondylotic cervical myelopathy (SCM). Little is known about the spontaneous course and prognosis of clinically "silent" presymptomatic spondylotic cervical cord compression (P-SCCC). The aim of the present study was to update a previously published model predictive for the development of clinically symptomatic SCM, and to assess the early and late risks of this event in a larger cohort of P-SCCC subjects. A group of 199 patients (94 women, 105 men, median age 51 years) with magnetic resonance signs of spondylotic cervical cord compression, but without clear clinical signs of myelopathy, was followed prospectively for at least 2 years (range 2-12 years). Various demographic, clinical, imaging, and electrophysiological parameters were correlated with the time for the development of symptomatic SCM. Clinical evidence of the first signs and symptoms of SCM within the follow-up period was found in 45 patients (22.6%). The 25th percentile time to clinically manifested myelopathy was 48.4 months, and symptomatic SCM developed within 12 months in 16 patients (35.5%). The presence of symptomatic cervical radiculopathy and electrophysiological abnormalities of cervical cord dysfunction detected by somatosensory or motor-evoked potentials were associated with time-to-SCM development and early development (< or =12 months) of SCM, while MRI hyperintensity predicted later (>12 months) progression to symptomatic SCM. The multivariate predictive model based on these variables correctly predicted early progression into SCM in 81.4% of the cases. In conclusion, electrophysiological abnormalities of cervical cord dysfunction together with clinical signs of cervical radiculopathy and MRI hyperintensity are useful predictors of early progression into symptomatic SCM in patients with P-SCCC. Electrophysiological evaluation of cervical cord dysfunction in patients with cervical radiculopathy or back pain is valuable. Meticulous follow-up is justified in high-risk P-SCCC cases.
通过影像学方法检测到的脊髓型颈椎病性脊髓压迫是脊髓型颈椎病（SCM）临床诊断的前提条件。关于临床“无症状”的症状前脊髓型颈椎病性脊髓压迫（P-SCCC）的自然病程和预后知之甚少。本研究的目的是更新先前发表的预测临床症状性SCM发生的模型，并在更大的P-SCCC受试者队列中评估该事件的早期和晚期风险。对一组199例患者（94例女性，105例男性，中位年龄51岁）进行了前瞻性随访至少2年（范围2 - 12年），这些患者有脊髓型颈椎病性脊髓压迫的磁共振征象，但无明确的脊髓病临床体征。各种人口统计学、临床、影像学和电生理参数与症状性SCM发生的时间相关。随访期间45例患者（22.6%）出现了SCM的首个体征和症状的临床证据。出现临床脊髓病的第25百分位数时间为48.4个月，16例患者（35.5%）在12个月内出现了症状性SCM。有症状的颈神经根病的存在以及通过体感或运动诱发电位检测到的颈髓功能障碍的电生理异常与SCM发生的时间以及SCM的早期发生（≤12个月）相关，而MRI高信号预示着后期（>12个月）进展为症状性SCM。基于这些变量的多变量预测模型在81.4%的病例中正确预测了早期进展为SCM。总之，颈髓功能障碍的电生理异常以及颈神经根病的临床体征和MRI高信号是P-SCCC患者早期进展为症状性SCM的有用预测指标。对有颈神经根病或背痛患者的颈髓功能障碍进行电生理评估是有价值的。对高危P-SCCC病例进行细致的随访是合理的。
