The Prevalence of Asymptomatic and Symptomatic Spinal Cord Compression on Magnetic Resonance Imaging: A Systematic Review and Meta-analysis

Abstract

Study design: Systematic review and meta-analysis.

Objectives: Cervical spinal cord compression (SCC) due to degenerative changes of the spine is a frequent finding on magnetic resonance imaging (MRI). While most people remain asymptomatic, a proportion develop symptoms of degenerative cervical myelopathy (DCM). DCM is an often-progressive neurological disease that can cause quadriplegia. The epidemiology of SCC and DCM is poorly understood. We sought to estimate the prevalence of degenerative cervical SCC and DCM from cross-sectional cohorts undergoing MRI.

Methods: We conducted a systematic review and meta-analysis of MRI reports on human subjects older than 16 years with degenerative SCC. A predetermined search strategy was used to identify relevant literature on MEDLINE. Title and abstract screenings were followed by full text screening. Data was extracted and analyzed by fixed or random-effects models.

Results: The present search returned 1506 publications. Following our exclusion criteria, 19 studies were included. Subgroup analysis of 3786 individuals estimated the prevalence of asymptomatic SCC in a healthy population as 24.2% with a significantly higher prevalence of SCC in older populations compared with younger populations and American/European populations compared with Asian populations. Subgroup analysis of 1202 individuals estimated the prevalence of DCM in a healthy population as 2.3%.

Conclusions: We present the first estimates of the prevalence of asymptomatic SCC and DCM. Studies investigating the epidemiology of SCC are heterogeneous in methodology and results. These data indicate the need for more studies into the epidemiology of SCC and DCM performed with consistent methodologies.

Keywords: cervical; degenerative cervical myelopathy; disc herniation; incidence; magnetic resonance imaging; myelopathy; ossification posterior longitudinal ligament; prevalence; spinal cord compression; spondylosis; spondylotic; stenosis.

Figure 1.

Search strategy used in MEDLINE.

Figure 2.

PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) flow diagram. A total of 1506 articles were screened for relevance, and 19 studies were included in this review. Thirteen studies that met the inclusion criteria were excluded due to a high risk of bias.

Figure 3.

Subgroup analysis of spinal cord compression (SCC) prevalence based on the pretest probability of SCC. The low pretest group contained healthy individuals with no known symptoms or disease. The uncertain pretest probability group contained individuals with symptoms or diseases not thought to be directly related to degenerative cervical myelopathy (DCM). These included individuals suffering from dizziness, headaches, radiculopathy, or fibromyalgia. The high pretest probability group included individuals suffering from symptoms or signs of DCM (and hence SCC would be expected) or possible related diseases such as lumbar spinal stenosis and traumatic spinal cord injury without major fracture. This high pretest probability subgroup had a significantly higher prevalence of SCC than any other subgroup.

Figure 4.

Subgroup analysis of the prevalence of spinal cord compression (SCC) in healthy participants separated by age and geographical location. (A) The studies included in the low pretest probability group in Figure 2 were divided based on a mean age of below or above 60 years. The over 60s subgroup had a significantly higher prevalence of SCC than the under 60s subgroup. (B) The studies included in the low pretest probability group in Figure 2 were divided based on the continent the study participants lived in. American/European participants had a significantly higher prevalence of SCCC compared with Asian populations.

Figure 5.

Subgroup analysis of the prevalence of degenerative cervical myelopathy (DCM) based on the pretest probability of DCM. The low pretest probability subgroup included individuals who entered their respective studies aware of no symptoms. The high pretest probability subgroup involved individuals who were recruited to the study because of their symptoms.