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Presymptomatic spondylotic cervical myelopathy: an updated predictive model
Josef Bednarik1, Zdenek Kadanka2, Ladislav Dusek3
1Department of Neurology, Faculty Hospital Brno and Medical Faculty of the Masaryk University, Jihlavská 20, 625 00, Brno, The Czech Republic. jbednar@fnbrno.cz.
Summary
Presymptomatic cervical cord compression can progress to symptomatic myelopathy. Electrophysiological tests, radiculopathy signs, and MRI findings predict this progression, aiding early detection and management of spondylotic cervical myelopathy.
Area of Science:
- Neurology
- Radiology
- Clinical Medicine
Background:
- Spondylotic cervical myelopathy (SCM) diagnosis requires imaging-confirmed cervical cord compression.
- The natural history and prognosis of asymptomatic or presymptomatic cervical cord compression (P-SCCC) remain poorly understood.
- Predictive models for symptomatic SCM development are needed to guide clinical management.
Purpose of the Study:
- To update a predictive model for symptomatic SCM development in patients with P-SCCC.
- To assess the early and late risks of developing symptomatic SCM in a larger cohort.
- To identify key predictors for progression from P-SCCC to symptomatic SCM.
Main Methods:
- Prospective follow-up of 199 patients with imaging-confirmed P-SCCC for at least 2 years (range 2-12 years).
- Correlation of demographic, clinical, imaging (including MRI hyperintensity), and electrophysiological parameters with time to symptomatic SCM development.
- Development and validation of a multivariate predictive model for early SCM progression.
Main Results:
- Symptomatic SCM developed in 22.6% of patients during follow-up.
- The 25th percentile time to myelopathy was 48.4 months; 35.5% of early progressions occurred within 12 months.
- Symptomatic cervical radiculopathy and electrophysiological abnormalities predicted early SCM (<12 months), while MRI hyperintensity predicted later progression (>12 months).
- The predictive model accurately identified early SCM progression in 81.4% of cases.
Conclusions:
- Electrophysiological abnormalities, clinical radiculopathy, and MRI hyperintensity are valuable predictors of early symptomatic SCM progression in P-SCCC.
- Electrophysiological evaluation is beneficial for patients with cervical radiculopathy or back pain.
- Meticulous follow-up is warranted for high-risk P-SCCC patients to prevent severe outcomes.