Clinical and Radiographic Predictors of Deterioration in Mild Cervical Spondylotic Myelopathy A Systematic Review
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Abstract
Background and Objectives. The management approach for mild cervical spondylotic myelopathy (CSM) is still unclear, and the decision to perform outright surgery remains a topic of debate. Therefore, identifying clinical and imaging predictors of deterioration is crucial.
Methodology. This study followed the PRISMA Guidelines and reviewed published articles from 2000 to 2023 that involved adult patients with asymptomatic spondylotic cord compression and/or mild CSM who underwent conservative management. The search was conducted in MEDLINE via Pubmed, Cochrane Central Register of Controlled Trials, Herding Plus, Embase, and Google Scholar. Patient demographics, neurologic outcome, and clinical and imaging predictors were examined. We assessed study quality using the Newcastle-Ottawa Scale (NOS) for observational studies. We reported statistical data as presented and calculated RRs or ORs if not provided. Evidence quality was evaluated using the GRADE approach.
Results. Twelve studies were included, consisting of 1,046 patients. Cervical radiculopathy, electrophysiological abnormalities (EMG, SEP, MEP), decreased Torg ratio <0.80, cervical range of motion of >50° and cervical instability (slippage >2 mm or segmental kyphosis) were significantly associated with myelopathy progression. MRI T2 hyperintensity of the spinal cord was associated with poor outcomes and delayed development of myelopathy. Furthermore, CSF column diameter, circumferential cord compression, cord T1 angular deformity, cross-sectional area (CSA) <70.1 mm2, and cord compression ratio <0.4 were independent predictors of developing myelopathy. Progression was associated more with focal than with diffuse disc herniation.
Conclusion. Early recognition of clinical features and imaging predictors of deterioration may help clinicians decide when to do early surgery in patients with mild CSM. Consensus is still needed on the role of surgery in patients with mild CSM. Patients may exhibit improvement, stability, or deterioration following conservative measures.
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