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Review
. 2024 May 10:15:1341371.
doi: 10.3389/fneur.2024.1341371. eCollection 2024.

Evidence-based commentary on the diagnosis, management, and further research of degenerative cervical spinal cord compression in the absence of clinical symptoms of myelopathy

Tomas Horak  1   2 , Magda Horakova  1   2 , Milos Kerkovsky  1   3 , Marek Dostal  3   4 , Petr Hlustik  5   6 , Jan Valosek  5   7   8   9 , Alena Svatkova  10   11 , Petr Bednarik  10   11 , Eva Vlckova  1   2 , Josef Bednarik  1   2
Affiliations
Review

Evidence-based commentary on the diagnosis, management, and further research of degenerative cervical spinal cord compression in the absence of clinical symptoms of myelopathy

Tomas Horak et al. Front Neurol. .

Abstract

Degenerative cervical myelopathy (DCM) represents the final consequence of a series of degenerative changes in the cervical spine, resulting in cervical spinal canal stenosis and mechanical stress on the cervical spinal cord. This process leads to subsequent pathophysiological processes in the spinal cord tissues. The primary mechanism of injury is degenerative compression of the cervical spinal cord, detectable by magnetic resonance imaging (MRI), serving as a hallmark for diagnosing DCM. However, the relative resilience of the cervical spinal cord to mechanical compression leads to clinical-radiological discordance, i.e., some individuals may exhibit MRI findings of DCC without the clinical signs and symptoms of myelopathy. This degenerative compression of the cervical spinal cord without clinical signs of myelopathy, potentially serving as a precursor to the development of DCM, remains a somewhat controversial topic. In this review article, we elaborate on and provide commentary on the terminology, epidemiology, natural course, diagnosis, predictive value, risks, and practical management of this condition-all of which are subjects of ongoing debate.

Keywords: cervical spinal canal stenosis; degenerative cervical cord compression; degenerative cervical myelopathy; magnetic resonance imaging; subclinical myelopathy.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The author(s) declared that they were an editorial board member of Frontiers, at the time of submission. This had no impact on the peer review process and the final decision.

Figures

Figure 1
Figure 1
Examples of different types and severities of cervical spinal cord compression in axial MRI images in asymptomatic degenerative cervical cord compression subjects, illustrating the weak correlation between the severity of compression and the development of clinical myelopathic symptoms and signs. (A) Small ventral focal compression („impingement“) with preserved cerebrospinal fluid space. (B) Flat ventral compression with flattened spinal cord and partially reduced ventral cerebrospinal fluid space. (C) Severe circular asymmetrical compression with flattening of the spinal cord and almost complete loss of cerebrospinal fluid space.
Figure 2
Figure 2
Sagittal and axial MRI sections of the cervical spinal cord showing degenerative compression in a patient with symptomatic degenerative cervical myelopathy (A,B) and in a patient without any myelopathic signs and symptoms (C,D), showing no visible difference in the severity of compression between DCM and ADCC subjects.
Figure 3
Figure 3
Diagram of the diagnosis and terminology of degenerative cervical spinal canal stenosis and subsequent cervical spinal cord compression.
See this image and copyright information in PMC

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