by B. Davies
If we took a hundred random individuals, over the age of 40 off the street, and performed a cervical MRI scan, as many as 56 would have imaging changes associated with myelopathy. However, fewer than 1 or 2 would actually have spinal cord injury and therefore actual myelopathy. These numbers may not be exact (although they were found in a recent study), but you get the gist. 
So a big question for researchers is what happens to the other 54 people…. Do they go on to get myelopathy? Is it just a question of time? Or will they remain unaffected?
There has only ever been one study looking at this by Joseph Bednarik. In that study they found that, given time, as many as 10 of the remaining 54 would get myelopathy .
In a follow up study published this month , Dr Bednarik has been looking at whether we can predict which of those 54 patients will develop myelopathy. They found that if a patient had had cervical radiculopathy, or electrophysiological signs of cord problems or more significant compression features on their MRI, they were more likely to develop myelopathy.
These findings need to be confirmed in larger studies, but they are interesting. For one, it suggests that features of cord injury (electrophysiology) come before any symptoms of myelopathy! We know that catching myelopathy early is important, but this is going to make things even more difficult!
1) Adamova, B., Kerkovsky, M., Kadanka, Z., Dusek, L., Jurova, B., Vlckova, E., & Bednarik, J. (2017). Predictors of symptomatic myelopathy in degenerative cervical spinal cord compression. Brain and Behavior, 7(9), e00797.
2) Bednarik, J., Kadanka, Z., Dusek, L., Kerkovsky, M., Vohanka, S., Novotny, O., et al. (2008). Presymptomatic spondylotic cervical myelopathy: an updated predictive model. European Spine Journal : Official Publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society, 17(3), 421–431.
3) Kovalova, I., Kerkovsky, M., Kadanka, Z., Nemec, M., Jurova, B., Dusek, L., et al. (2016). Prevalence and Imaging Characteristics of Non-Myelopathic and Myelopathic Spondylotic Cervical Cord Compression. Spine.
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