School of Clinical Medicine, University of Cambridge, Cambridge, UK.
Department of Neurosurgery, University of Cambridge, Cambridge, UK.
J Clin Neurosci. 2022 May;99:53-61. doi: 10.1016/j.jocn.2022.03.002. Epub 2022 Mar 4.
Degenerative cervical myelopathy (DCM) is a progressive cervical spinal cord injury brought about by mechanical stress from degenerative changes in the cervical spine. It is typically diagnosed on clinical symptoms and examination findings together with MRI findings. In this study, we explore the significance of these degenerative pathology to onset of DCM by performing the first meta-analysis on the prevalence of degenerative features reported on MRI amongst healthy and asymptomatic populations and compare this to the prevalence of degenerative features reported on MRI amongst a symptomatic population calculated in a previous review. We conducted a systematic review and meta-analysis in accordance with PRISMA guidelines, cognizant of their adaptation for epidemiological studies. A search strategy was used to identify original research carrying out MRI screening of cervical spines of asymptomatic patients in MEDLINE and Embase from 1985 to present day. The search yielded a total of 1098 studies of which 17 were included in this meta-analysis covering a total of 5059 patients. Ossification of posterior longitudinal ligament (pooled asymptomatic prevalence of 0.4%, 95% Confidence Interval [0.1%, 0.8%]), enlargement of ligamentum flavum (pooled asymptomatic prevalence of 11.8%, 95% Confidence Interval [5.3%, 18.4%]) and degenerative multilevel disc pathology (pooled asymptomatic prevalence of 64.5%, 95% Confidence Interval [48.3%, 80.8%], I 100%) were found to be significantly lower in asymptomatic populations. Symptomatic populations have a prevalence of 10.5% (95% Confidence Interval [7.7%, 13.3%]) for ossification of posterior longitudinal ligament, 56.8% (95% Confidence Interval [52.3%, 61.3%]) for enlargement of ligamentum flavum and 89.7% (95% Confidence Interval [86.9%, 92.5%]) for degenerative multilevel disc pathology [18]. Understanding the natural history of DCM is a recognised research priority, and whilst these perspectives require further evaluation, they may be of significant relevance to the evolving biomechanical understanding of the disease.
退行性颈脊髓病（DCM）是一种由颈椎退行性改变引起的进行性颈脊髓损伤。它通常根据临床症状和检查结果以及 MRI 结果进行诊断。在这项研究中，我们通过对无症状和无明显症状人群的 MRI 上退行性特征的患病率进行首次荟萃分析，探讨这些退行性病理变化与 DCM 发病的相关性，并将其与之前综述中报告的有症状人群的 MRI 上退行性特征的患病率进行比较。我们按照 PRISMA 指南进行了系统评价和荟萃分析，并意识到它们适用于流行病学研究。我们使用检索策略在 MEDLINE 和 Embase 中检索了从 1985 年至今对无症状患者颈椎进行 MRI 筛查的原始研究。该检索共产生了 1098 项研究，其中 17 项研究纳入了本荟萃分析，共纳入了 5059 例患者。后纵韧带骨化（无症状人群的汇总患病率为 0.4%，95%置信区间 [0.1%，0.8%]）、黄韧带肥厚（无症状人群的汇总患病率为 11.8%，95%置信区间 [5.3%，18.4%]）和退行性多节段椎间盘病变（无症状人群的汇总患病率为 64.5%，95%置信区间 [48.3%，80.8%]，I 2 =100%）在无症状人群中明显较低。有症状人群的后纵韧带骨化患病率为 10.5%（95%置信区间 [7.7%，13.3%]），黄韧带肥厚患病率为 56.8%（95%置信区间 [52.3%，61.3%]），退行性多节段椎间盘病变患病率为 89.7%（95%置信区间 [86.9%，92.5%]）。了解 DCM 的自然病史是一个公认的研究重点，尽管这些观点需要进一步评估，但它们可能与疾病的不断发展的生物力学理解具有重要的相关性。
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