Physical performance decreases in the early stage of cervical myelopathy before the myelopathic signs appear: the Wakayama Spine Study

  • Keiji Nagata
  • Noriko Yoshimura
  • Hiroshi HashizumeEmail author
  • Hiroshi Yamada
  • Yuyu Ishimoto
  • Shigeyuki Muraki
  • Yukihiro Nakagawa
  • Akihito Minamide
  • Hiroyuki Oka
  • Hiroshi Kawaguchi
  • Sakae Tanaka
  • Kozo Nakamura
  • Munehito Yoshida
Original Article



We previously revealed a prevalence rate of 24.4% for cervical cord compression (CCC) in a population-based magnetic resonance imaging study. This study aimed to investigate the occurrence of cervical myelopathy (CM) among CCC cases and to reveal the predictors for CM.


This study is a part of “The Wakayama Spine Study,” a large-scale population-based MRI cohort study. At baseline, 238 patients were diagnosed with CCC. We followed 238 patients who had CCC for more than 4 years, of which 158 (mean age, 68.9 years) participated in the second survey (follow-up rate, 66.3%). In the second survey, de novo CM was defined clinically as the presence of myelopathic signs (e.g., Hoffmann reflex, hyperreflexia of the patellar tendon, and Babinski reflex). Physical performance on 10-s grip and release test (GRT), grip strength, 6-m walking time at a usual and a maximal pace, step length at a usual and a maximal pace, chair stand time (CST), and one-leg standing (OLS) time was measured.


Among the 158 participants, nine (mean age, 68.8 years; incidence rate, 6.3%) were newly diagnosed with CM in the second survey. CST, 6-m walking time at a usual and a maximal pace, and step length at a maximal pace had already decreased in the de novo CM (+) participants at baseline compared to baseline findings of de novo (−) CM participants, but not the grip strength, OLS, or GRT.


We clarified the incidence rate of CM in CCC patients and the predictors of de novo CM.

Graphical abstract

These slides can be retrieved under Electronic Supplementary Material.


Myelopathic signs Physical performance Population-based cohort Presymptomatic cervical myelopathy Wakayama Spine Study 



This study was supported by: Wakayama Medical Award for Young Researchers in 2014, a Grant-in-Aid for Young Scientist 18K17391 to Keiji Nagata, H23-Choujyu-002 (Director, Toru Akune), H-25-Choujyu-007 (Director, Noriko Yoshimura), H25-Nanchitou (Men)-005 (Director, Sakae Tanaka), 201417014A (Director, Noriko Yoshimura), and H22-Choujyu-Wakate-007 (Director, Shigeyuki Muraki) from the Ministry of Health, Labour and Welfare; a Grant-in-Aid for Scientific Research (B26293139, B23390172 to Noriko Yoshimura, B2629333, C20591774 to Shigeyuki Muraki, C26462249 to Hiroshi Hashizume, C25462305 to Hiroshi Yamada); a Grant-in-Aid for Young Researchers (B25860448 to Yuyu Ishimoto, B26860419 to Ryohei Kagotani, B15K20013 to Hiroki Iwahashi); a Grant-in-Aid for Challenging Exploratory Research (15K15219 to Noriko Yoshimura, 26670307 to Shigeyuki Muraki, 24659666 to Hiroyuki Oka, 25670293 to Toru Akune) of JSPS KAKENHI grant; this study also was supported by grants from the Japan Osteoporosis Society (Noriko Yoshimura, Shigeyuki Muraki, Hiroyuki Oka, and Toru Akune), a grant from JA Kyosai Research Institute (Hiroyuki Oka), grants from Mitsui Sumitomo Insurance Welfare Foundation (Shigeyuki Muraki), and research aid from the Japanese Orthopedic Association (JOA-Subsidized Science Project Research 2006-1 and 2010-2; Director, Hiroshi Kawaguchi). The study sponsors played no role in the study design, the collection, analysis, and interpretation of data, writing of the report, or the decision to submit the paper for publication. The corresponding author had full access to all the data and had the final decision to submit for publication.

Compliance with ethical standards

Conflicts of interest


Supplementary material

586_2019_5907_MOESM1_ESM.pptx (813 kb)
Supplementary material 1 (PPTX 812 kb)


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Keiji Nagata
    • 1
  • Noriko Yoshimura
    • 2
  • Hiroshi Hashizume
    • 1
    Email author
  • Hiroshi Yamada
    • 1
  • Yuyu Ishimoto
    • 1
  • Shigeyuki Muraki
    • 2
  • Yukihiro Nakagawa
    • 3
  • Akihito Minamide
    • 1
  • Hiroyuki Oka
    • 4
  • Hiroshi Kawaguchi
    • 5
  • Sakae Tanaka
    • 6
  • Kozo Nakamura
    • 7
  • Munehito Yoshida
    • 1
    • 8
  1. 1.Department of Orthopaedic SurgeryWakayama Medical UniversityWakayama CityJapan
  2. 2.Department of Preventive Medicine for Locomotive Organ Disorders, 22nd Century Medical and Research Center, Faculty of MedicineThe University of TokyoTokyoJapan
  3. 3.Department of Orthopaedic SurgeryWakayama Medical University Kihoku HospitalWakayama CityJapan
  4. 4.Department of Medical Research and Management for Musculoskeletal Pain, 22nd Century Medical and Research Center, Faculty of MedicineThe University of TokyoTokyoJapan
  5. 5.Department of Orthopaedic Surgery, Tokyo Neurological CenterTokyoJapan
  6. 6.Department of Orthopaedic Surgery, Faculty of MedicineThe University of TokyoTokyoJapan
  7. 7.Rehabilitation Services BureauNational Rehabilitation Center for Persons with DisabilitiesTokorozawa CityJapan
  8. 8.Department of Orthopedic SurgerySumiya Orthopedic HospitalWakayama CityJapan

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