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Degenerative cervical myelopathy - update and future directions.
Nature Reviews Neurology ( IF 28.2 ) Pub Date : 2020-01-23 , DOI: 10.1038/s41582-019-0303-0
Jetan H Badhiwala 1 , Christopher S Ahuja 1 , Muhammad A Akbar 1 , Christopher D Witiw 2 , Farshad Nassiri 1 , Julio C Furlan 3 , Armin Curt 4 , Jefferson R Wilson 2 , Michael G Fehlings 1
Affiliation  

Degenerative cervical myelopathy (DCM) is the leading cause of spinal cord dysfunction in adults worldwide. DCM encompasses various acquired (age-related) and congenital pathologies related to degeneration of the cervical spinal column, including hypertrophy and/or calcification of the ligaments, intervertebral discs and osseous tissues. These pathologies narrow the spinal canal, leading to chronic spinal cord compression and disability. Owing to the ageing population, rates of DCM are increasing. Expeditious diagnosis and treatment of DCM are needed to avoid permanent disability. Over the past 10 years, advances in basic science and in translational and clinical research have improved our understanding of the pathophysiology of DCM and helped delineate evidence-based practices for diagnosis and treatment. Surgical decompression is recommended for moderate and severe DCM; the best strategy for mild myelopathy remains unclear. Next-generation quantitative microstructural MRI and neurophysiological recordings promise to enable quantification of spinal cord tissue damage and help predict clinical outcomes. Here, we provide a comprehensive, evidence-based review of DCM, including its definition, epidemiology, pathophysiology, clinical presentation, diagnosis and differential diagnosis, and non-operative and operative management. With this Review, we aim to equip physicians across broad disciplines with the knowledge necessary to make a timely diagnosis of DCM, recognize the clinical features that influence management and identify when urgent surgical intervention is warranted.

中文翻译:

变性性颈椎病-更新和未来方向。

变性性颈椎病(DCM)是全球成人脊髓功能障碍的主要原因。DCM涵盖与颈椎脊柱退变有关的各种后天性(年龄相关性)和先天性病理,包括韧带,椎间盘和骨组织的肥大和/或钙化。这些病理使椎管狭窄,导致慢性脊髓压迫和残疾。由于人口老龄化,DCM的比率正在增加。需要迅速诊断和治疗DCM,以避免永久性残疾。在过去的10年中,基础科学以及转化和临床研究的进步增进了我们对DCM病理生理学的理解,并有助于描述基于证据的诊断和治疗方法。对于中度和重度DCM,建议进行手术减压。轻度脊髓病的最佳策略仍不清楚。下一代定量微结构MRI和神经生理学记录有望对脊髓组织损伤进行量化,并有助于预测临床结果。在此,我们对DCM进行了全面,循证的评估,包括其定义,流行病学,病理生理学,临床表现,诊断和鉴别诊断以及非手术和手术管理。通过本综述,我们旨在为广泛学科的医生提供及时诊断DCM,认识影响管理的临床特征并确定何时需要紧急外科手术的必要知识。轻度脊髓病的最佳策略仍不清楚。下一代定量微结构MRI和神经生理学记录有望对脊髓组织损伤进行量化,并有助于预测临床结果。在此,我们对DCM进行了全面,循证的评估,包括其定义,流行病学,病理生理学,临床表现,诊断和鉴别诊断以及非手术和手术管理。通过本综述,我们旨在为广泛学科的医生提供及时诊断DCM,认识影响管理的临床特征并确定何时需要紧急外科手术的必要知识。轻度脊髓病的最佳策略仍不清楚。下一代定量微结构MRI和神经生理学记录有望对脊髓组织损伤进行量化,并有助于预测临床结果。在此,我们对DCM进行了全面,循证的评估,包括其定义,流行病学,病理生理学,临床表现,诊断和鉴别诊断以及非手术和手术管理。通过本综述,我们旨在为广泛学科的医生提供及时诊断DCM,认识影响管理的临床特征并确定何时需要紧急外科手术的必要知识。下一代定量微结构MRI和神经生理学记录有望对脊髓组织损伤进行量化,并有助于预测临床结果。在此,我们对DCM进行了全面,循证的评估,包括其定义,流行病学,病理生理学,临床表现,诊断和鉴别诊断以及非手术和手术管理。通过本综述,我们旨在为广泛学科的医生提供及时诊断DCM,认识影响管理的临床特征并确定何时需要紧急外科手术的必要知识。下一代定量微结构MRI和神经生理学记录有望对脊髓组织损伤进行量化,并有助于预测临床结果。在此,我们对DCM进行了全面,循证的评估,包括其定义,流行病学,病理生理学,临床表现,诊断和鉴别诊断以及非手术和手术管理。通过本综述,我们旨在为广泛学科的医生提供及时诊断DCM,认识影响管理的临床特征并确定何时需要紧急外科手术的必要知识。诊断和鉴别诊断,以及非手术和手术管理。通过本综述,我们旨在为广泛学科的医生提供及时诊断DCM,认识影响管理的临床特征并确定何时需要紧急外科手术的必要知识。诊断和鉴别诊断,以及非手术和手术管理。通过本综述,我们旨在为广泛学科的医生提供及时诊断DCM,认识影响管理的临床特征并确定何时需要紧急外科手术的必要知识。
更新日期:2020-01-23
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