An Approach to Subclinical Cervical Myelopathy: A Case Report

Cervical myelopathy is a spinal cord lesion caused by cervical stenosiscompressing the spinal cord and vascular structures. Despite the common occurrence and large amount of information has been published about cervical myelopathy for at least 50 years, the effectiveness of the conservative and surgical treatments on the natural history, pathogenesis and especially the prognosis of the disease is still controversial. As a result of this controversy, in everyday clinical practice many doctors are still hesitant to commit themselves to a treatment regimen and are unable to predict the natural course of the disease. Although cervical cord compression is prerequisite for the clinical diagnosis and detected easily by myelomalacic signal changes on MRI, previous studies have demonstrated the existence of asymptomatic spinal cord compression detected by MRI. Little is known about the spontaneous course and prognosis of clinically "silent" or "subclinical" cervical cord myelomalasia. In addition, conflicting data on the prognosis and the treatment of this subclinical patient group exist in the literature. In order to determine the prognosis and patient-specific treatment modality; duration of symptoms, detailed neurological assessment made at regular intervals, electrophysiological findings, clinical myelopathy scoring methods such as the Japanese Orthopaedic Association Score as well as myelomalacic changes should be taken into consideration and decision-making must then be based on the evaluation of all these information. In this report, we aimed to report a 54-year-old man with subclinical cervical cord myelomalasia and to discuss the clinical and radiological findings, prognosis and optimal treatment regimen in the light of the literature. Turk I Phys Med Rehab 2012;58:335-9.