Magnetic resonance imaging findings and clinical characteristics of patients with degenerative cervical Myelopathy at Moi Teaching and Referral Hospital

Abstract

Background: Degenerative Cervical Myelopathy (DCM) is a progressive neurological disorder attributed to extrinsic cervical spinal cord compression by age-related spinal column structural changes. DCM is a unifying diagnostic term for all degenerative pathology that compress the cervical spinal cord which include spondylosis and ligamentous aberrations. It has subtle onset, progressive course and varied clinical presentation. It can be clinically determined but accurately diagnosed using Magnetic Resonance Imaging (MRI) which is a noninvasive non- ionizing imaging modality of choice. Despite being the commonest cause of non-traumatic cervical spinal cord injury among adults contributing up to 23.6% cervical myelopathy globally, there is paucity of literature of this disease in Africa. Objective: To describe the cervical spine MRI findings of patients with DCM in relation to their clinical characteristics at Moi Teaching and Referral Hospital (MTRH). Methods: A cross-sectional study was carried out in the Radiology and Imaging department of MTRH between January and December 2017. Fifty seven patients with degenerative cervical myelopathy-related neurological symptoms and cervical MRI findings who met the eligibility criteria were recruited. Informed consent was sought before data was collected using structured questionnaires. Data was analyzed using Stata/ MP Version 13. Categorical variables were summarized as frequencies and percentages while continuous variables as mean, median and standard deviation. Associations between categorical variables were assessed using Fisher exact test. A p values of less than 0.05 was considered statistically significant. Results were presented using tables and charts Results: The mean age of the participants was 51.7 years (±13.3) and the male to female ratio was 1:1.4. Cervical spondylosis was the commonest cause of DCM. The most frequent location for both maximum cord compression (43.7 %) and spinal cord hyperintense foci as seen on T2 Weighted Image (T2WI) (36.8%) was at C5-C6 level. All patients with congenitally narrow cervical vertebral canal, based on a Spinal Cord Occupation Ratio (SCOR) of ≥70%, had spinal cord T2WI hyperintense foci. There was a statistically significant association between presence of spinal cord T2WI hyperintense foci and neurological symptoms of more than one year (81%, p= 0.0007). Conclusion: Spondylosis was the commonest cause of DCM. C5-C6 level was the most frequently location for maximum cord compression. Patients with inborn narrow cervical vertebral canal and those who reported of neurological symptoms lasting for more than one year were more likely to have T2WI hyperintense foci within their spinal cord. Recommendations: High index of suspicion of spondylosis and C5-C6 cervical spine level involvement in patients suspected with DCM. Assessment of vertebral canal caliber in patients with degenerative cervical spine pathology