This systematic review and meta-analysis pooled 19 MRI studies (6,755 subjects) to generate the first prevalence estimates for asymptomatic cervical spinal cord compression and degenerative cervical myelopathy. It addresses a core epidemiologic gap: how common is cord compression in people who feel fine, and how often does it progress to myelopathy?
A cervical MRI showing cord compression is a common incidental finding, not a diagnosis. Roughly 1 in 4 asymptomatic adults harbor structural SCC on imaging, and that fraction exceeds 1 in 3 after age 60.
When you see cord compression on a cervical MRI ordered for neck pain or radiculopathy, correlation with clinical signs of myelopathy is mandatory before attributing any symptoms to it. Hoffman's sign, hyperreflexia, hand clumsiness, and gait dysfunction are what make the diagnosis — not the image alone.
Conversely, the 2.3% true DCM prevalence versus near-zero surgical rates means most myelopathy is missed in practice. In any patient over 60 presenting with unexplained falls, hip fracture, or progressive hand dysfunction, actively screen for DCM. One referenced series found 18% of hip fracture patients had unrecognized myelopathy.
T2 hyperintensity on MRI is a late marker of cord injury. Using it as your primary diagnostic criterion will miss most structural SCC and most early DCM.
This systematic review and meta-analysis pooled 19 MRI studies (6,755 subjects) to generate the first prevalence estimates for asymptomatic cervical spinal cord compression and degenerative cervical myelopathy. It addresses a core epidemiologic gap: how common is cord compression in people who feel fine, and how often does it progress to myelopathy?
A cervical MRI showing cord compression is a common incidental finding, not a diagnosis. Roughly 1 in 4 asymptomatic adults harbor structural SCC on imaging, and that fraction exceeds 1 in 3 after age 60.
When you see cord compression on a cervical MRI ordered for neck pain or radiculopathy, correlation with clinical signs of myelopathy is mandatory before attributing any symptoms to it. Hoffman's sign, hyperreflexia, hand clumsiness, and gait dysfunction are what make the diagnosis — not the image alone.
Conversely, the 2.3% true DCM prevalence versus near-zero surgical rates means most myelopathy is missed in practice. In any patient over 60 presenting with unexplained falls, hip fracture, or progressive hand dysfunction, actively screen for DCM. One referenced series found 18% of hip fracture patients had unrecognized myelopathy.
T2 hyperintensity on MRI is a late marker of cord injury. Using it as your primary diagnostic criterion will miss most structural SCC and most early DCM.