Abstract：
METHODS: Narrative review.
OBJECTIVE: To discuss the current understanding of the natural history of degenerative cervical myelopathy (DCM).
METHODS: Literature review summarizing current evidence pertaining to the natural history and risk factors of DCM.
RESULTS: DCM is a common condition in which progressive arthritic disease of the cervical spine leads to spinal cord compression resulting in a constellation of neurological symptoms, in particular upper extremity dysfunction and gait impairment. Anatomical factors including cord-canal mismatch, congenitally fused vertebrae and genetic factors may increase individuals\' risk for DCM development. Non-myelopathic spinal cord compression (NMSCC) is a common phenomenon with a prevalence of 24.2% in the healthy population, and 35.3% among individuals >60 years of age. Clinical radiculopathy and/or electrophysiological signs of cervical cord dysfunction appear to be risk factors for myelopathy development. Radiological progression of incidental Ossification of the Posterior Longitudinal Ligament (OPLL) is estimated at 18.3% over 81-months and development of myelopathy ranges between 0-61.5% (follow-up ranging from 40 to 124 months between studies) among studies. In patients with symptomatic DCM undergoing non-operative treatment, 20-62% will experience neurological deterioration within 3-6 years.
CONCLUSIONS: Current estimates surrounding the natural history of DCM, particularly those individuals with mild or minimal impairment, lack precision. Clear predictors of clinical deterioration for those treated with non-operative care are yet to be identified. Future studies are needed on this topic to help improve treatment counseling and clinical prognostication.
OBJECTIVE: To discuss the current understanding of the natural history of degenerative cervical myelopathy (DCM).
METHODS: Literature review summarizing current evidence pertaining to the natural history and risk factors of DCM.
RESULTS: DCM is a common condition in which progressive arthritic disease of the cervical spine leads to spinal cord compression resulting in a constellation of neurological symptoms, in particular upper extremity dysfunction and gait impairment. Anatomical factors including cord-canal mismatch, congenitally fused vertebrae and genetic factors may increase individuals\' risk for DCM development. Non-myelopathic spinal cord compression (NMSCC) is a common phenomenon with a prevalence of 24.2% in the healthy population, and 35.3% among individuals >60 years of age. Clinical radiculopathy and/or electrophysiological signs of cervical cord dysfunction appear to be risk factors for myelopathy development. Radiological progression of incidental Ossification of the Posterior Longitudinal Ligament (OPLL) is estimated at 18.3% over 81-months and development of myelopathy ranges between 0-61.5% (follow-up ranging from 40 to 124 months between studies) among studies. In patients with symptomatic DCM undergoing non-operative treatment, 20-62% will experience neurological deterioration within 3-6 years.
CONCLUSIONS: Current estimates surrounding the natural history of DCM, particularly those individuals with mild or minimal impairment, lack precision. Clear predictors of clinical deterioration for those treated with non-operative care are yet to be identified. Future studies are needed on this topic to help improve treatment counseling and clinical prognostication.
摘要：
方法：叙事回顾。
目的：探讨目前对退行性颈椎病（DCM）自然史的认识。
方法：文献综述总结了目前有关DCM自然史和危险因素的证据。
结果：DCM是一种常见病，其中颈椎进行性关节炎疾病导致脊髓压迫，导致一系列神经系统症状，特别是上肢功能障碍和步态障碍。解剖学因素，包括脊髓管不匹配，先天性融合的椎骨和遗传因素可能会增加个体患DCM的风险。非脊髓性脊髓压迫（NMSCC）是一种常见的现象，在健康人群中患病率为24.2％，年龄>60岁的个体中占35.3%。临床神经根病和/或颈索功能障碍的电生理体征似乎是脊髓病发展的危险因素。在81个月内，后纵向韧带（OPLL）偶然骨化的放射学进展估计为18.3％，脊髓病的发展范围为0-61.5％（研究之间的随访时间为40至124个月）。在有症状的DCM患者接受非手术治疗，20-62％将在3-6年内经历神经系统恶化。
结论：目前围绕DCM自然史的估计，特别是那些轻度或轻度损伤的人，缺乏精度。对于那些接受非手术治疗的患者，临床恶化的明确预测因素尚未确定。需要对该主题进行未来的研究，以帮助改善治疗咨询和临床预后。
目的：探讨目前对退行性颈椎病（DCM）自然史的认识。
方法：文献综述总结了目前有关DCM自然史和危险因素的证据。
结果：DCM是一种常见病，其中颈椎进行性关节炎疾病导致脊髓压迫，导致一系列神经系统症状，特别是上肢功能障碍和步态障碍。解剖学因素，包括脊髓管不匹配，先天性融合的椎骨和遗传因素可能会增加个体患DCM的风险。非脊髓性脊髓压迫（NMSCC）是一种常见的现象，在健康人群中患病率为24.2％，年龄>60岁的个体中占35.3%。临床神经根病和/或颈索功能障碍的电生理体征似乎是脊髓病发展的危险因素。在81个月内，后纵向韧带（OPLL）偶然骨化的放射学进展估计为18.3％，脊髓病的发展范围为0-61.5％（研究之间的随访时间为40至124个月）。在有症状的DCM患者接受非手术治疗，20-62％将在3-6年内经历神经系统恶化。
结论：目前围绕DCM自然史的估计，特别是那些轻度或轻度损伤的人，缺乏精度。对于那些接受非手术治疗的患者，临床恶化的明确预测因素尚未确定。需要对该主题进行未来的研究，以帮助改善治疗咨询和临床预后。
