Presymptomatic spondylotic cervical myelopathy: an updated predictive model
Presymptomatic spondylotic cervical myelopathy: an updated predictive model
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DOI：
10.1007/s00586-008-0585-1
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发表时间：
2008-03-01
影响因子：
2.8
通讯作者：
Kratochvilova, Dagmar
中科院分区：
文献类型：
--
作者：
Bednarik, Josef;Kadanka, Zdenek;Kratochvilova, Dagmar
影像学检测脊髓压迫是临床诊断脊髓型颈椎病的前提。临床上“无症状”的前症状性颈椎脊髓压迫症（P-SCCC）的自发过程和预后知之甚少。本研究的目的是更新先前发表的预测临床症状性SCM发展的模型，并在更大的P-SCCC受试者队列中评估该事件的早期和晚期风险。一组199例患者（94例女性，105例男性，中位年龄51岁），有脊柱颈脊髓压迫的磁共振体征，但没有明确的脊髓病临床体征，前瞻性随访至少2年（范围2-12年）。各种人口统计学、临床、影像学和电生理学参数与症状性SCM的发展时间相关。45例患者（22.6%）在随访期内发现了SCM的首次体征和症状的临床证据。第25百分位数至临床表现为脊髓病的时间为48.4个月，16名患者（35.5%）在12个月内出现症状性SCM。通过体感或运动诱发电位检测到的症状性颈神经根病和颈髓功能障碍的电生理异常的存在与SCM发展的时间和症状性SCM的早期发展（12个月）进展相关。基于这些变量的多变量预测模型在81.4%的病例中正确预测了早期进展为SCM。总之，颈髓功能障碍的电生理异常以及颈神经根病的临床体征和MRI高信号是P-SCCC患者早期进展为症状性SCM的有用预测因子。神经根型颈椎病或背痛患者的颈髓功能障碍的电生理评估是有价值的。在高风险的P-SCCC病例中，MEDICAL随访是合理的。
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 ( 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.