49 DCM-Related Degenerative Spinal Changes in the Healthy: Meta-Analysis & Comparison to a Symptomatic Cohort. (19th August 2022) - Banerjee, Arkaprabha
Abstract: Aim: Degenerative cervical myelopathy (DCM) is a progressive cervical spinal cord injury brought about by mechanical stress from degenerative changes in the cervical spine. It is typically diagnosed on clinical symptoms, examination findings together with MRI findings. The objective was to determine the significance of category of degenerative pathology (identified in Nouri et al, 2017) to onset of DCM, by comparing symptomatic and asymptomatic populations. Method: A systematic review and meta-analysis were conducted in accordance with the PRISMA guidelines, cognizant of their adaptation for epidemiological studies. A search strategy was used to identify original research carrying out MRI screening of cervical spines of asymptomatic patients in MEDLINE and Embase from 1985 to the present day. Results: The search yielded a total of 1, 098 studies of which 17 were included in this meta-analysis, covering a total of 5, 059 patients. Ossification of posterior longitudinal ligament (pooled asymptomatic prevalence of 0.4%), enlargement of ligamentum flavum (pooled asymptomatic prevalence of 11.8%) and degenerative multilevel disc pathology (pooled asymptomatic prevalence of 64.5%, I 2 100%) were found to be significantly lower in asymptomatic populations (factor of 25 times, 4 times and 1.5 times respectively), and thus associated with DCM. Conclusions: Ossification of posterior longitudinal ligament and enlargement of ligamentum flavum were found to be markedly lower in asymptomatic populations, possibly significantly implicating ligamentous pathology in the onset of DCM. Understanding the natural history of DCM is a recognised research priority, and whilst these perspectives require further evaluation, they may be of significance to the evolving biomechanical understanding of the disease.