A Clinical And Imaging Evaluation Of Cervical Degeneration And Correlation To Cervical Spondylotic Myelopathy

Objective: Due to cervical disc degeneration and neck trauma factors,cervical bone hyperplasia, disc herniation and ligament hypertrophy lead tothe cervical spinal canal or foraminal deformation and stenosis. Theimpingements stimulate and oppress cervical spinal cord, nerve roots andvascular, resulting in a series of symptoms.The main symptoms of cervicalspondylosis are as follows: neck and shoulder pain, dizziness, upper limbstring numbness, muscle atrophy, lower limbs spasm, difficulty walking, andeven limb paralysis, bowel and bladder dysfunction. Cervical spondylosis iscommon in the general population, which is mostly degenerative. Uniformtypes divided into five categories are: nerve root type, myelopathy type,vertebral artery type, sympathetic type and esophageal compression type.Cervical myelopathy is defined as that cervical disc herniation, ligamenthypertrophy, ossification, leading to cervical spinal stenosis, spinal cordcompression or ischemia and spinal cord dysfunction. The main clinicalmanifestations of cervical spondylotic myelopathy are ataxia, limb numbness,bowel and bladder dysfunction. With the health care of China is booming,MRI technology has been widely used in the primary hospital, and thedetection rate of cervical cord compression has increased. Patients withcervical degeneration or spinal cord dural sac compression image but withoutcomplaints were not uncommon in the physical examination. Thisphenomenon was named as “asymptomatic spondylotic cervical cordcompression” by domestic scholars. Absence of symptoms refers to the typicalsigns and symptoms of upper motor neuron damage, not including neckactivity limitation, neck, shoulder and radicular pain. In this study, weinvestigate the clinical and imaging changes of cervical degenerative diseasesand correlation to cervical spondylotic myelopathy. Methods: A retrospective review of clinical records of patients evaluatedin our outpatient setting at a single institution by a single surgeon for cervicaldegenerative diseases was performed from Mar.2011to Nov.2012.Myelopathy was defined as the presence of more than one long-tract signlocalized to the cervical spinal cord (Hoffman sign, Babinski sign,hyperreflexia, clonus, and/or gait dysfunction) on physical examination in theabsence of other neurologic diseases. The presence of long-tract signs, MRIimaging features of cervical cord compression, intraparenchymal cord signalabnormality on T2weighted MRI, the stability of cervical spine and patientdemographics were recorded. Eighty eight patients met inclusion criteria (agemore than18years, with signs and symptoms of cervical degenerativediseases and complete clinical and radiologic assessment). Of these,48caseshad clinical findings of cervical myelopathy and defined study group. Theremaining40cases were not found myelopathic signs on physical examinationand defined control group. Differences of age between the two groups wereexamined using the unpaired t test. Differences of gender, the presence of cordcompression and hyperintense signal on T2weighted MRI within the spinalcord parenchyma, and segmental cervical instability between the two groupswere examined using chisquare test. The correlation of these factors tocervical myelopathy was analysed using Logistic regression analysis.Results: The mean age of the study group was52.4±9.2years, butpatients of control group had an increased mean age58.6±8.9years (P＜0.01).There was no correlation between the presence of myelopathy and gender (P＞0.05). Radiographic features of cervical cord compression were present in48cases of study group, but only10cases of control group had the presenceof cord compression on MRI (P＜0.01). Twenty seven cases of study grouppresented with hyperintense signal on T2weighted MRI within the spinal cordparenchyma, whereas only five cases of control group presented (P＜0.01).52%of study group’s patients demonstrated segmental cervical instability onX-ray plate, but only30%of control group’s patients were observed (P＜0.01).Logistic regression analysis on the subset with cord compression indicates that the likelihood of myelopathy for the patients with cord compressionincreasedwith age, the presence of cord signal hyperintensity and segmental cervicalinstability.Conclusion: Diagnosis of cervical myelopathy is based on clinicalmanifestations, physical examination and imaging studies. Many factors arerelevant to myelopathy. For the patients with cord compression, the likelihoodof myelopathy increased with age, the presence of cord signal hyperintensityand segmental cervical instability.