Correlative Anatomy of Cervical Spondylotic Myelopathy

Parke, Wesley W.

doi:10.1097/00007632-198807000-00023

Cited by 103 publications

(55 citation statements)

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“…Other findings diagnostic of, or consistent with, cervical myelopathy included a positive Hoffman sign, positive Romberg sign, impaired tandem walk and ankle clonus [1,9]. The abnormal pyramidal tract findings were accentuated by neck extension and flexion, maneuvers known to aggravate spinal cord compression in the face of spinal stenosis or ventral cervical disc protrusion or bone spurs [1,4,7,26,40,41,42,50]. The bilateral involvement of the upper and lower extremities and the presence of a high thoracic sensory level would localize the neurological abnormalities to the cervical spinal cord or cervicomedullary junction and would be consistent with, if not diagnostic of, the clinical diagnosis of cervical myelopathy.…”

Section: Discussionmentioning

confidence: 99%

“…Neck extension is known to reduce the antero-posterior spinal canal diameter as a result of increased disc protrusion, infolding of the ligamentum flavum and the gliding action facilitated by the horizontal orientation of the facet articular surfaces [4,26,40,42,48,50]. As the cervical spine is a dynamic structure, we felt that dynamic imaging would be more informative than static imaging.…”

Section: Discussionmentioning

confidence: 99%

“…The gantry angle was altered to obtain images perpendicular to the spine at each level, despite the exaggerated lordosis attendant on neck extension. The mid-sagittal antero-posterior dimension of the spinal canal was determined at the level of the intervertebral disc space on both neutral and extended neck images [42]. The actual diameter available to accommodate the spinal cord, dura mater and cerebrospinal fluid was determined by measuring the distance between the posteriormost projection of the intervertebral disc, anteriorly, and the ligamentum flavum or lamina, posteriorly, as determined by which structure was most contiguous to the dorsal surface of the dura.…”

Section: Radiological Imagingmentioning

confidence: 99%

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Clinical evidence for cervical myelopathy due to Chiari malformation and spinal stenosis in a non-randomized group of patients with the diagnosis of fibromyalgia

et al. 2004

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Radiological Imagingmentioning

confidence: 99%

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Clinical evidence for cervical myelopathy due to Chiari malformation and spinal stenosis in a non-randomized group of patients with the diagnosis of fibromyalgia

et al. 2004

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“…The gantry angle was altered to obtain images perpendicular to the spine at each level despite the exaggerated lordosis attendant on neck extension. The mid-sagittal antero-posterior dimension of the spinal canal was determined at the level of the intervertebral disc space on both neutral and extended neck images [34]. The actual diameter available to accommodate the spinal cord, dura mater and cerebrospinal fluid was determined by measuring the distance between the posterior most projection of the intervertebral disc anteriorly and the ligamentum flavum or lamina posteriorly as determined by which structure was most contiguous to the dorsal surface of the dura.…”

Section: Radiological Imagingmentioning

confidence: 99%

Treatment of cervical myelopathy in patients with the fibromyalgia syndrome: outcomes and implications

et al. 2007

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Some patients with fibromyalgia also exhibit the neurological signs of cervical myelopathy. We sought to determine if treatment of cervical myelopathy in patients with fibromyalgia improves the symptoms of fibromyalgia and the patients' quality of life. A non-randomized, prospective, case control study comparing the outcome of surgical (n = 40) versus non-surgical (n = 31) treatment of cervical myelopathy in patients with fibromyalgia was conducted. Outcomes were compared using SF-36, screening test for somatization, HADS, MMPI-2 scale 1 (Hypochondriasis), and self reported severity of symptoms 1 year after treatment. There was no significant difference in initial clinical presentation or demographic characteristics between the patients treated by surgical decompression and those treated by non-surgical means. There was a striking and statistically significant improvement in all symptoms attributed to the fibromyalgia syndrome in the surgical patients but not in the non-surgical patients at 1 year following the treatment of cervical myelopathy (P £ 0.018-0.001, Chi-square or Fisher's exact test). At the 1 year follow-up, there was a statistically significant improvement in both physical and mental quality of life as measured by the SF-36 score for the surgical group as compared to the non-surgical group (Repeated Measures ANOVA P < 0.01). There was a statistically significant improvement in the scores from Scale 1 of the MMPI-2 and the screening test for somatization disorder, and the anxiety and depression scores exclusively in the surgical patients (Wilcoxon signed rank, P < 0.001). The surgical treatment of cervical myelopathy due to spinal cord or caudal brainstem compression in patients carrying the diagnosis of fibromyalgia can result in a significant improvement in a wide array of symptoms usually attributed to fibromyalgia with attendant measurable improvements in the quality of life. We recommend detailed neurological and neuroradiological evaluation of patients with fibromyalgia in order to exclude compressive cervical myelopathy, a potentially treatable condition.

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“…A strong correlation has been demonstrated between narrowing of the sagittal diameter of the cervical spine and the development of CSM. [8][9][10][11][12] The second component is the dynamic mechanical factor, characterized by repetitive movement of the compressed spinal cord. In flexion, the spinal cord lengthens, which results in axial tension and, potentially, ischemia.…”

mentioning

confidence: 99%

Treatment considerations of cervical spondylotic myelopathy

Shiban

Meyer

2014

Neur Clin Pract

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SummaryCervical spondylotic myelopathy (CSM) is the leading cause of myelopathy in patients over age 50 years. Despite advances, CSM remains a clinical diagnosis and its natural history remains unclear. The treatment of CSM is controversial, especially in patients with mild or moderate clinical disease without rapid progression of symptoms. Herein, we begin with a clinical vignette followed by a brief description of the clinical problems. We discuss evaluation, treatment, and recommendations for the treatment of CSM. Emphasis is drawn to areas of uncertainty and present level of evidence for the treatment modalities of CSM.C ervical spondylotic myelopathy (CSM) is a degenerative condition of the cervical spine and the leading cause of myelopathy in those over the age of 50. 1-3 The exact incidence and prevalence of CSM is unknown. 1 Initially, patients may present with any of the following symptoms: neck pain and decreased mobility of the cervical spine, numb or clumsy hands, unsteady gait, hyperreflexia, and spasticity. In time, upper extremity weakness, muscle atrophy, or sphincter dysfunction might develop. [4][5][6][7] Clinical vignette A 61-year-old teacher with a history of intermittent neck pain is seen after 5 months of continuing neck pain. MRI 2 months after the onset of pain showed degenerative changes with spinal stenosis in the cervical region. He is very anxious because the first physician he consulted recommended decompressive surgery and the second recommended conservative treatment and to avoid surgery. He read on the Internet that he could eventually become paralyzed and therefore seeks further opinions. How should this patient be evaluated and treated?The pathophysiology of CSM involves 3 main components. The first component is the static factor, where structural changes cause spinal canal stenosis and cord compression. A strong correlation has been demonstrated between narrowing of the sagittal diameter of the cervical

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Correlative Anatomy of Cervical Spondylotic Myelopathy

Cited by 103 publications

References 0 publications

Clinical evidence for cervical myelopathy due to Chiari malformation and spinal stenosis in a non-randomized group of patients with the diagnosis of fibromyalgia

Clinical evidence for cervical myelopathy due to Chiari malformation and spinal stenosis in a non-randomized group of patients with the diagnosis of fibromyalgia

Treatment of cervical myelopathy in patients with the fibromyalgia syndrome: outcomes and implications

Treatment considerations of cervical spondylotic myelopathy

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