BACKGROUND Both idiopathic normal pressure hydrocephalus (iNPH) and cervical myelopathy may result in progressive gait impairment. Some patients who do not respond to shunting despite a positive tap test may have gait dysfunction from cervical myelopathy. The objective of this study was to determine the prevalence of cervical myelopathy in patients with iNPH. METHODS A consecutive series of patients undergoing shunt placement for iNPH were screened for cervical stenosis. Clinical manifestations of iNPH and cervical myelopathy, grade of cervical stenosis, cervical spine surgical intervention, timing of intervention, and outcomes were recorded. RESULTS Fifty-two patients shunted for treatment of iNPH were included for analysis. 58 % were male with a mean age of 75.2 years (SD 7.3 years). All patients presented with gait disturbances. 39/52 (75 %) had cervical stenosis, and 9/52 (17.3 %) had significant (grade 2-3) cervical stenosis with myelopathy and were subsequently treated with surgical decompression. There was an association between increasing grade of stenosis and disproportionately enlarged subarachnoid space hydrocephalus (DESH). All patients with grade 2-3 cervical stenosis and symptoms of cervical myelopathy in addition to iNPH underwent cervical decompression surgery. CONCLUSIONS Clinically significant cervical myelopathy was prevalent in patients with iNPH and was associated with increased rate of DESH, a finding that requires validation in a larger cohort. Based on these results, cervical imaging could be considered preoperatively in patients with iNPH, particularly when upper motor neuron findings are identified. Additionally, concomitant cervical stenosis should be ruled out in patients whose gait does not improve after shunt placement.

中文翻译：

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特发性正常压力脑积水患者颈椎病的高患病率

背景 特发性正常压力脑积水 (iNPH) 和脊髓型颈椎病都可能导致进行性步态障碍。尽管敲击试验呈阳性但对分流无反应的一些患者可能因脊髓型颈椎病而出现步态功能障碍。本研究的目的是确定 iNPH 患者中颈椎病的患病率。方法 对一系列因 iNPH 接受分流术的患者进行宫颈狭窄筛查。记录iNPH和脊髓型颈椎病的临床表现、颈椎管狭窄程度、颈椎手术干预、干预时机和结局。结果 分流治疗 iNPH 的 52 名患者被纳入分析。58% 为男性，平均年龄为 75.2 岁（标准差 7.3 岁）。所有患者都出现步态障碍。39/52 (75 %) 有颈椎管狭窄症，9/52 (17.3 %) 有显着（2-3 级）颈椎管狭窄伴脊髓病，随后接受手术减压治疗。狭窄程度增加与蛛网膜下腔不成比例扩大的脑积水 (DESH) 之间存在关联。除 iNPH 外，所有患有 2-3 级颈椎管狭窄症和脊髓型颈椎病症状的患者均接受了颈椎减压手术。结论 临床上显着的脊髓型颈椎病在 iNPH 患者中普遍存在，并且与 DESH 发生率增加相关，这一发现需要在更大的队列中进行验证。基于这些结果，可以在 iNPH 患者术前考虑宫颈成像，特别是在确定上运动神经元发现时。此外，