Cervical Spondylotic Myelopathy: Natural Course and the Value of Diagnostic Techniques –WFNS Spine Committee Recommendations

Abstract

ObjectiveThis study presents the results of a systematic literature review conducted to determine most up-to-date information on the natural outcome of cervical spondylotic myelopathy (CSM) and the most reliable diagnostic techniques. MethodsA literature search was performed for articles published during the last 10 years. ResultsThe natural course of patients with cervical stenosis and signs of myelopathy is quite variable. In patients with no symptoms, but significant stenosis, the risk of developing myelopathy with cervical stenosis is approximately 3% per year. Myelopathic signs are useful for the clinical diagnosis of CSM. However, they are not highly sensitive and may be absent in approximately one-fifth of patients with myelopathy. The electrophysiological tests to be used in CSM patients are motor evoked potential (MEP), spinal cord evoked potential, somatosensory evoked potential, and electromyography (EMG). The differential diagnosis of CSM from other neurological conditions can be accomplished by those tests. MEP and EMG monitoring are useful to reduce C5 root palsy during CSM surgery. Notable spinal cord T2 hyperintensity on cervical magnetic resonance imaging (MRI) is correlated with a worse outcome, whereas lighter signal changes may predict better outcomes. T1 hypointensity should be considered a sign of more advanced disease. ConclusionThe natural course of CSM is quite variable. Signal changes on MRI and some electrophysiological tests are valuable adjuncts to diagnosis.

Perioperative Outcomes in 17,947 Patients Undergoing 2-Level Anterior Cervical Discectomy and Fusion Versus 1-Level Anterior Cervical Corpectomy for Treatment of Cervical Degenerative Conditions: A Propensity Score Matched National Surgical Quality Improvement Program Analysis

“…Spondylosis leading to cervical radiculopathy and cervical myelopathy can significantly impair the quality of life of affected patients. [1][2][3] Compared to nonoperative management of symptomatic moderate to severe cervical spondylosis, surgical treatment has been shown to result in improved functional status, decreased pain, and better overall patient prognosis. [4][5][6][7] In fact, cervical spondylosis remains one of the most common disorders treated by spine surgeons with a nearly 7-fold increase in the number of cervical fusions performed in recent years.…”

Unilateral Degenerative Facet Joint Pathology Eliciting Rapidly Progressive Cervical Spondylotic Myelopathy

“…One reason might be because it is sometimes more difficult to determine the actual affected spinal segment in CSM patients without DCS or cervical instability. It is quite common for patients with symptomatic CSM to have multilevel spinal canal stenosis on radiological examination; false-positive or asymptomatic spinal degeneration is not unusual [8], especially in elderly patients. In the present case, it was fortunately easy to determine the actual affected spinal segment.…”

Successful Motor Evoked Potential Monitoring in Cervical Myelopathy : Related Factors and the Effect of Increased Stimulation Intensity

“…Despite several conflicting opinions, the IONM to be applied in cervical myelopathy patients consist of the following (in order of benefits) : MEP, spinal cord evoked potential, SSEP, and electromyography. Although the MEP has been found to be a significant parameter for predicting outcomes of cervical myelopathy surgery, there is no evidence that it is more valuable than clinical parameters [ 40 ]. Several studies on MEP monitoring in cervical myelopathy have reported its efficacy in terms of sensitivity and specificity during spine surgery [ 12 , 22 , 32 , 33 ].…”