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Management of asymptomatic cervical spinal stenosis in the setting of symptomatic tandem lumbar stenosis: A review.
MedLine Citation:
PMID:  25036872     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
INTRODUCTION: This article reviews the literature regarding tandem asymptomatic cervical stenosis in the setting of symptomatic lumbar stenosis. The presenting features of cervical spondylotic myelopathy are insidious and consistent with upper motor neuron loss. Often, asymptomatic cervical stenosis is encountered in the clinical setting during the workup of a symptomatic lumbar stenosis and degenerative disease.
METHODS: A PubMed (1966 to July 2013) electronic database search was conducted for articles pertaining to the diagnosis of incidentally discovered cervical cord compression. Keywords and MESH terms were limited to asymptomatic cervical stenosis, asymptomatic cervical compression, asymptomatic spinal stenosis, asymptomatic cervical spondylosis, and asymptomatic cervical cord signal. The primary literature topics for manuscript inclusion were the development of symptomatic myelopathy from asymptomatic cord signal edema, as well as the presence of tandem stenosis as defined above by incidental cervical stenosis during the workup of lumbar degenerative disease.
RESULTS: There were no previous systematic reviews, randomized trials, or prospective studies on the management of tandem cervical and thoracic stenosis. Five studies, all retrospective reviews containing relevant data were included in the review. Asymptomatic cervical stenosis encountered in the investigation of lumbar symptoms was had a 23% incidence. A risk of 5% per year of development of myelopathy previously reported.
CONCLUSIONS: There is insufficient evidence in the literature to support the need for preemptive decompression for asymptomatic cervical cord compression with or without a correlative T2 hyperintense cord signal. Early diagnosis of radiculopathy or myelopathy in patients with cervical stenosis (i.e., through conversion of asymptomatic to symptomatic state) is important as each patient with in this clinical setting should be followed closely, as the literature shows the tendency for a clinical progression to eventual cervical myelopathy.
Authors:
George M Ghobrial; Mark E Oppenlander; Christopher M Maulucci; Matthew Viereck; Srinivas Prasad; Ashwini D Sharan; James S Harrop
Publication Detail:
Type:  REVIEW     Date:  2014-7-2
Journal Detail:
Title:  Clinical neurology and neurosurgery     Volume:  124C     ISSN:  1872-6968     ISO Abbreviation:  Clin Neurol Neurosurg     Publication Date:  2014 Jul 
Date Detail:
Created Date:  2014-7-18     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7502039     Medline TA:  Clin Neurol Neurosurg     Country:  -    
Other Details:
Languages:  ENG     Pagination:  114-118     Citation Subset:  -    
Copyright Information:
Copyright © 2014 Elsevier B.V. All rights reserved.
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