STUDY DESIGN: We conducted a cohort study of clinically asymptomatic spondylotic cervical cord compression cases with the primary end point of the development of clinical signs of cervical myelopathy. OBJECTIVES: To investigate whether various demographic, clinical, radiologic, and electrophysiological parameters could predict progression from clinically asymptomatic (preclinical) spondylotic cervical cord compression to symptomatic myelopathy. SUMMARY OF BACKGROUND DATA: The data available on the prediction of the outcome in surgical and conservative treatment of spondylotic cervical myelopathy are controversial. Little is known about the clinical natural history of asymptomatic magnetic resonance image-detected spondylotic cervical cord compression and/or changes of signal intensity. METHODS: A group of 66 patients (32 women, 34 men, median age 50 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, 2-8 years; median, 4 years). Various demographic, clinical, imaging, and electrophysiological parameters were correlated with clinical outcome. RESULTS: Clinical signs of myelopathy during the follow-up period were detected in 13 patients (19.7%). The only variables significantly associated with the development of clinically symptomatic spondylotic cervical myelopathy (SCM) were the presence of symptomatic cervical radiculopathy, electromyographic signs of anterior horn lesion, and abnormal somatosensory-evoked potentials. A multivariate logistic regression model based on these variables correctly classified 90% of cases into 2 subgroups: a group with development of symptomatic SCM and that without clinical manifestation of subclinical cervical cord compression. CONCLUSIONS: Electrophysiological abnormalities together with clinical signs of cervical radiculopathy could predict clinical manifestation of preclinical spondylotic cervical cord compression.

• MeSH
• buňky předních rohů míšních fyziologie   MeSH
• časná diagnóza MeSH
• dospělí MeSH
• elektromyografie MeSH
• kohortové studie MeSH
• komprese míchy diagnostické zobrazování   etiologie   patofyziologie   MeSH
• krční obratle * MeSH
• lidé středního věku MeSH
• lidé MeSH
• magnetická rezonanční tomografie MeSH
• motorické evokované potenciály MeSH
• následné studie MeSH
• osteofytóza páteře komplikace   diagnostické zobrazování   patofyziologie   MeSH
• progrese nemoci MeSH
• prospektivní studie MeSH
• radiografie MeSH
• senioři MeSH
• somatosenzorické evokované potenciály MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH

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.

• MeSH
• dospělí MeSH
• elektrodiagnostika metody   MeSH
• evokované potenciály fyziologie   MeSH
• kohortové studie MeSH
• komprese míchy diagnóza   patofyziologie   MeSH
• krční obratle patologie   patofyziologie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• magnetická rezonanční tomografie MeSH
• mícha patofyziologie   MeSH
• modely neurologické * MeSH
• nervové dráhy patofyziologie   MeSH
• osteofytóza páteře diagnóza   patofyziologie   MeSH
• prediktivní hodnota testů MeSH
• prognóza MeSH
• progrese nemoci MeSH
• prospektivní studie MeSH
• radikulopatie diagnóza   patofyziologie   MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH