Cervical Myelomalacia, Cervical Radiculopathy
Conditions
Keywords
Cervical Radicular Pain, Cervical Spinal Cord Signal Abnormality, Myelomalacia, Spinal Cord Compression, Hoffman
Brief summary
This prospective observational study aims to determine the prevalence of cervical spinal cord signal abnormalities, including myelomalacia, among adult patients presenting to a tertiary pain clinic with cervical radicular pain. A total of 400 consecutive patients will be enrolled. Clinical and neurological examination findings, including the Hoffmann sign and other findings suggestive of cervical spinal cord involvement, will be recorded together with cervical magnetic resonance imaging (MRI) findings obtained as part of routine clinical care. The primary outcome is the prevalence of cervical spinal cord signal abnormalities, including myelomalacia, on cervical MRI. Secondary outcomes include the treatment strategy selected during routine clinical care, clinical and radiological factors associated with treatment selection, the relationship between the Hoffmann sign and cervical spinal cord abnormalities, and referral for surgical evaluation. This is an observational study. Participation in the study will not determine or alter diagnostic or treatment decisions, which will be made by the treating physician according to routine clinical practice.
Interventions
DIAGNOSTIC_TESTClinical and Cervical MRI Assessment
Participants will undergo routine clinical and neurological evaluation, including assessment of the Hoffmann sign and other neurological findings, together with evaluation of cervical magnetic resonance imaging (MRI) findings. Cervical MRI findings, including spinal canal stenosis, spinal cord compression, intramedullary signal abnormalities, and myelomalacia, will be recorded. All assessments are performed as part of routine clinical care. No diagnostic procedure or treatment is assigned by the study protocol.
Sponsors
Ankara City Hospital Bilkent
Study design
Observational model
COHORT
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Healthy volunteers
No
Inclusion criteria
* Age 18 years or older * Presentation to the pain clinic with cervical radicular pain * Clinical symptoms and/or examination findings consistent with cervical nerve root involvement * Availability of a cervical magnetic resonance imaging (MRI) examination suitable for evaluation * Completion of standardized neurological examination at the initial visit * Ability and willingness to provide written informed consent
Exclusion criteria
* Previous cervical spine surgery * Acute cervical spine trauma * Known cervical spinal malignancy * Active spinal infection * Known inflammatory, demyelinating, or other non-degenerative spinal cord disease * Severe cognitive impairment or communication difficulty preventing reliable clinical assessment * Inadequate or non-diagnostic cervical MRI quality * Refusal to participate
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Prevalence of Cervical Spinal Cord Signal Abnormalities Including Myelomalacia | At the initial clinical evaluation (baseline) | The proportion of participants with cervical spinal cord signal abnormalities identified on cervical magnetic resonance imaging (MRI), including intramedullary T2-weighted signal abnormalities and findings consistent with myelomalacia, will be determined. The prevalence will be calculated as the number of participants with these MRI findings divided by the total number of enrolled participants with evaluable cervical MRI examinations. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Planned Treatment Strategy | At the initial clinical evaluation (baseline) | The treatment strategy selected during routine clinical care will be recorded for each participant. Management will be categorized as interventional pain procedure, medical treatment without intervention, referral for surgical evaluation, or other clinically appropriate management. |
| Clinical and Radiological Factors Associated With Interventional Treatment Selection | At the initial clinical evaluation (baseline) | The association between predefined clinical and radiological variables and the decision to plan an interventional pain procedure will be evaluated. Variables will include Hoffmann sign, motor deficit, hyperreflexia, Babinski sign, clonus, gait abnormality, central canal stenosis, spinal cord compression, intramedullary signal abnormality, and myelomalacia. |
| Association Between Hoffmann Sign and Cervical Spinal Cord Signal Abnormalities | At the initial clinical evaluation (baseline) | The relationship between Hoffmann sign status and cervical spinal cord abnormalities on MRI will be evaluated. The frequency of spinal cord signal abnormalities and myelomalacia will be compared between participants with positive and negative Hoffmann signs. |
| Referral for Surgical Evaluation | At the initial clinical evaluation (baseline) | The proportion of participants referred for neurosurgical or spine surgical evaluation following clinical and radiological assessment will be determined, and factors associated with referral will be explored. |
Countries
Turkey (Türkiye)
Contacts
CONTACTÜlkü Sabuncu, Assoc prof
Outcome results
None listed