SYSTEMATIC REVIEW OF AUTONOMIC AND RESPIRATORY IMPAIRMENTS IN CERVICAL COMPRESSIVE MYELOPATHY

Background: Cervical myelopathies are progressive conditions caused by chronic compression of the spinal cord due to degenerative changes or other structural factors. While motor impairments are the predominant symptoms, disruption of autonomic and respiratory pathways in the spinal cord can lead to dysfunction in these systems as well. This systematic review aimed to comprehensively evaluate the evidence on autonomic and pulmonary dysfunction occurring in patients with cervical compressive myelopathies. Methods: We systematically searched major electronic databases including MEDLINE, Embase, and CENTRAL for studies reporting on autonomic or pulmonary impairments in adults with degenerative cervical myelopathy, ossification of the posterior longitudinal ligament, or other cervical compressive myelopathies. Screening, data extraction and quality assessments were conducted in duplicate. Findings were synthesized narratively. Results: 28 studies (n=1,642 patients) met eligibility criteria. Autonomic dysfunctions identified included abnormal heart rate variability parameters, altered sweating/temperature regulation, neurogenic bladder, and erectile dysfunction. The pooled prevalence of neurogenic bladder among 8 studies was 48% (95% CI 33-62%). For pulmonary dysfunction, diaphragmatic paralysis and respiratory failure requiring ventilator support was relatively uncommon (<10%) but sleep disordered breathing and decreased respiratory muscle strength were more prevalent (20-50% range). Both autonomic and pulmonary impairments correlated with increased myelopathy severity, particularly among patients with lesions involving the lower cervical cord. Conclusions: Autonomic and pulmonary deficits occur in a substantial subset of patients with cervical myelopathies, frequently correlating with lesion severity. Screening and management of these non-motor impairments is important for optimizing functional status and quality of life. Additional high-quality research on the epidemiology, mechanisms, and clinical implications of these complications is needed.