Yurac Ratko, Matamala José Manuel, Zamorano Juan José, Harrop James S, Davies Benjamin M, Nouri Aria, Fehlings Michael G
Unidad de Columna, Departamento de Ortopedia y Traumatología, Clínica Alemana de Santiago, Santiago, Chile.
Laboratorio de Neurología y Neurofisiología Traslacional, Facultad de Medicina, Universidad de Chile, Santiago, Chile.
Rev Med Chil. 2022 Mar;150(3):339-352. doi: 10.4067/S0034-98872022000300339.
Degenerative cervical myelopathy (DCM) is the most common cause of spinal cord dysfunction in adults. Its prevalence is increasing as a result of population aging. The diagnosis of DCM is often delayed or overlooked, resulting in secondary neurologic morbidity. The natural course of DCM typically presents as a gradual neurological deterioration, with symptoms ranging from muscle weakness to complete paralysis, with variable degrees of sensory deficits and sphincter dysfunction. Magnetic resonance imaging (MRI) and electrophysiological studies allow the assessment of spinal cord function and its structural damage to determine treatment and clinical outcomes. All patients with signs and symptoms consistent with DCM should be referred to a spine surgeon for assessment and tailored treatment. Those patients with mild DCM can be managed non-operatively but require close monitoring and education about potentially alarming signs and symptoms. Surgery is not currently recommended for asymptomatic patients with evidence of spinal cord compression or cervical spinal stenosis on MRI, but they require a structured follow-up. Patients with moderate or severe DCM require surgical decompression to avoid further progression. The objective of this review is to raise awareness of degenerative cervical myelopathy and its increasing prevalence as well as to aid non-surgical healthcare workers for a timely diagnosis and management of this disabling condition.
退行性颈椎脊髓病(DCM)是成人脊髓功能障碍最常见的原因。由于人口老龄化,其患病率正在上升。DCM的诊断常常被延迟或忽视,从而导致继发性神经功能损害。DCM的自然病程通常表现为神经功能逐渐恶化,症状从肌肉无力到完全瘫痪不等,伴有不同程度的感觉障碍和括约肌功能障碍。磁共振成像(MRI)和电生理研究有助于评估脊髓功能及其结构损伤,以确定治疗方法和临床结果。所有有与DCM相符的体征和症状的患者都应转诊给脊柱外科医生进行评估和个体化治疗。那些轻度DCM患者可以进行非手术治疗,但需要密切监测,并就潜在的警示体征和症状进行教育。目前,对于MRI显示有脊髓压迫或颈椎管狭窄证据的无症状患者,不建议进行手术,但他们需要进行结构化随访。中度或重度DCM患者需要手术减压以避免病情进一步发展。本综述的目的是提高对退行性颈椎脊髓病及其不断上升的患病率的认识,并帮助非手术医护人员及时诊断和管理这种致残性疾病。