Prevalence of Cervical Myelomalacia in Adult Patients Requiring a Cervical Magnetic Resonance Imaging

Study Design. A retrospective study. Objective. To determine the prevalence of cervical myelomalacia in patients requiring cervical magnetic resonance imaging. Summary of Background Data. The presence of myelomalacia in the cervical spinal cord in has prognostic value after decompression surgery. Some surgeons consider operative treatment of all patients with myelomalacia based on the assumption that myelomalacia is a relatively uncommon finding. However, the prevalence of cervical myelomalacia in symptomatic patients has not been fully established. Methods. The sentences containing the key word "myelomalacia" were extracted from a large database of cervical magnetic resonance imaging reports and manually reviewed by an experienced neuroradiologist to determine whether the interpreting radiologists thought there was myelomalacia in the cervical spinal cord. The prevalence of myelomalacia was calculated for different age and sex groups, as well as for the medical specialties/subspecialties of the referring providers. Results. A total of 964 of 23,139 patients who underwent magnetic resonance imaging findings consistent with cervical myelomalacia. The overall prevalence of myelomalacia in this population was 4.2%; 5.6% in males and 3.0% in females. The rates increased linearly with age until the eighth decade when it reached 7.6% overall, 9.2% for males and 6.2% for females, but dropped to 5.1% for patients older than 80. There were considerable variations in the prevalence of myelomalacia in patients referred by different specialties/subspecialties. Specialists in spinal cord injury had the highest rate (28.7%), followed by neurological (8.4%) and orthopedic (6.4%) spine surgeons, general neurosurgeons (5.5%), and neurologists (4.2%). Specialists who generally do not treat patients with spine problems had the lowest (1.2%) followed by nonspine orthopedists (1.6%) and primary care doctors (2.1%). Conclusion. The overall prevalence of cervical myelomalacia was relatively low in the studied population, and it was affected by age, sex, and the specialties/subspecialties of referring providers. These results may help direct treatment guidelines and allow for informed discussions with patients in terms of the risk versus the benefit of surgery.