Degenerative Cervical Myelopathy Epidemiology, Genetics, and Pathogenesis
Degenerative Cervical Myelopathy Epidemiology, Genetics, and Pathogenesis
复制标题
DOI：
10.1097/brs.0000000000000913
复制
发表时间：
2015-06-15
期刊：
影响因子：
3
通讯作者：
Fehlings, Michael G.
中科院分区：
文献类型：
--
作者：
Nouri, Aria;Tetreault, Lindsay;Fehlings, Michael G.
研究设计. Review.Objective.正式引入“退行性颈椎病”（DCM）作为描述导致脊髓病的各种颈椎退行性疾病的总体术语。在此，详细描述了属于该上位词的疾病的流行病学、发病机制和遗传学。脊髓型颈椎病的非创伤性、退行性形式是成人脊髓损伤的最常见原因，包括脊髓型颈椎病、后纵韧带骨化、黄韧带骨化和退行性椎间盘疾病。不幸的是，既没有一个特定的术语，也没有一个特定的诊断国际疾病分类，第十次修订代码来描述这一系列临床实体。这导致了在提到由于颈椎退行性疾病引起的脊髓病患者时，诊断术语的使用不一致。叙述性回顾。结果。在北美，由于脊柱退变引起的脊髓病的发病率和患病率估计至少分别为每百万人41例和605例。脊髓型颈椎病相关住院的发病率估计为4.04/100，000人-年，手术率似乎在上升。在病理生理学上，脊髓病是由静态压迫、导致脊髓张力和血管供应改变的脊柱对线不良以及动态损伤机制引起的。职业危害，包括头顶负重运输货物，以及其他风险因素可能会加速DCM的发展。潜在的遗传因素包括与MMP-2和胶原IX相关的退行性椎间盘疾病，以及与胶原VI和XI相关的后纵韧带骨化。此外，先天性异常包括椎管狭窄、唐氏综合征和Klippel-Feil综合征可能易患DCM。尽管DCM可以作为单独的诊断实体存在，但它们高度相关，经常伴随出现，从临床角度来看表现相似，并且似乎部分是由于颈椎的逐渐老化和磨损而补偿和改善稳定性的反应。提倡使用“退行性颈椎病”一词。
Study Design. Review.Objective. To formally introduce "degenerative cervical myelopathy" (DCM) as the overarching term to describe the various degenerative conditions of the cervical spine that cause myelopathy. Herein, the epidemiology, pathogenesis, and genetics of conditions falling under this hypernym are carefully described.Summary of Background Data. Nontraumatic, degenerative forms of cervical myelopathy represent the commonest cause of spinal cord impairment in adults and include cervical spondylotic myelopathy, ossification of the posterior longitudinal ligament, ossification of the ligamentum flavum, and degenerative disc disease. Unfortunately, there is neither a specific term nor a specific diagnostic International Classification of Diseases, Tenth Revision code to describe this collection of clinical entities. This has resulted in the inconsistent use of diagnostic terms when referring to patients with myelopathy due to degenerative disease of the cervical spine.Methods. Narrative review.Results. The incidence and prevalence of myelopathy due to degeneration of the spine are estimated at a minimum of 41 and 605 per million in North America, respectively. Incidence of cervical spondylotic myelopathy-related hospitalizations has been estimated at 4.04/100,000 person-years, and surgical rates seem to be rising. Pathophysiologically, myelopathy results from static compression, spinal malalignment leading to altered cord tension and vascular supply, and dynamic injury mechanisms. Occupational hazards, including transportation of goods by weight bearing on top of the head, and other risk factors may accelerate DCM development. Potential genetic factors include those related to MMP-2 and collagen IX for degenerative disc disease, and collagen VI and XI for ossification of the posterior longitudinal ligament. In addition, congenital anomalies including spinal stenosis, Down syndrome, and Klippel-Feil syndrome may predispose to the development of DCM.Conclusion. Although DCMs can present as separate diagnostic entities, they are highly interrelated, frequently manifest concomitantly, present similarly from a clinical standpoint, and seem to be in part a response to compensate and improve stability due to progressive age and wear of the cervical spine. The use of the term "degenerative cervical myelopathy" is advocated.