Current Management of Cervical Spondylotic Myelopathy

Abstract

Cervical spondylotic myelopathy (CSM) develops insidiously as degenerative changes of the cervical spine impact the spinal cord. Unfortunately, CSM is a form of spinal cord injury in older patients that often experiences delayed treatment. This summary evaluates the pathophysiology, natural history, diagnosis, and current management of CSM. Frequently, patients do not appreciate or correlate their symptomatology with cervical spine disease, and those with radiographic findings may be clinically asymptomatic. Providers should remember the classic symptoms of CSM-poor hand dexterity, new unsteady gait patterns, new onset and progressive difficulty with motor skills. An magnetic resonance imaging is required in patients with suspected CSM, but computerized tomography myelography is an alternative in patients with implants as contraindications to magnetic resonance imaging. The management of those with CSM has continued to be a controversial topic. In general, patients with incidental findings of cervical cord compression that are asymptomatic can be managed conservatively. Those with daily moderate-severe disease that significantly affects activities of daily living should be treated operatively.

Level-specific Perioperative and Clinical Outcome Comparison: Cervical Disk Replacement Versus Anterior Cervical Diskectomy and Fusion at C5-C6 in Patients With Myeloradiculopathy

“…1 With a reported incidence of cervical myelopathy-related hospitalizations at 4.04/100,000 person-years, increasing focus has been placed on early identification, treatment, and prevention. 1,2 Treatment progresses from conservative nonsurgical measures, such as anti-inflammatory medications, physical therapy, and corticosteroid injections, to surgical approaches aimed at definitively addressing the underlying anatomical abnormality. 2 The symptomatology of cervical myelopathy can vary for both the degree of cervical canal stenosis and the portion of the spinal cord being compressed.…”

“…1,2 Treatment progresses from conservative nonsurgical measures, such as anti-inflammatory medications, physical therapy, and corticosteroid injections, to surgical approaches aimed at definitively addressing the underlying anatomical abnormality. 2 The symptomatology of cervical myelopathy can vary for both the degree of cervical canal stenosis and the portion of the spinal cord being compressed. 2 Reported symptoms include spasticity, hyperreflexia, pathologic reflexes, digit/hand clumsiness, weakness, decreased cervical range of motion, neck pain, radiculopathy, and gait disturbance, all of which negatively affect quality of life and disability status.…”

“…2 The symptomatology of cervical myelopathy can vary for both the degree of cervical canal stenosis and the portion of the spinal cord being compressed. 2 Reported symptoms include spasticity, hyperreflexia, pathologic reflexes, digit/hand clumsiness, weakness, decreased cervical range of motion, neck pain, radiculopathy, and gait disturbance, all of which negatively affect quality of life and disability status. 2 Although the aforementioned conservative treatment measures are often used, there exists evidence to support the notion that patients who are progressively symptomatic benefit from early consideration of a surgical approach.…”

“…The C5, C6, and C7 levels are most commonly involved with cervical pathology. 2 Two routinely used surgical approaches for cervical stabilization are anterior cervical diskectomy and fusion (ACDF) and cervical disk replacement (CDR). 2,5 ACDF is an established treatment modality for cervical myelopathy but may cause transient-to-chronic dysphagia and prevertebral softtissue swelling.…”

“…2 Two routinely used surgical approaches for cervical stabilization are anterior cervical diskectomy and fusion (ACDF) and cervical disk replacement (CDR). 2,5 ACDF is an established treatment modality for cervical myelopathy but may cause transient-to-chronic dysphagia and prevertebral softtissue swelling. 5 CDR emerged as a means of alleviating spinal cord compression while preserving cervical mobility.…”