Degenerative Cervical Myelopathy: A Review of Current Concepts

Abstract

Herbert von Luschka, a German anatomist, was the first to describe the developmental changes in the anatomical structures of the cervical spine. Degenerative cervical myelopathy (DCM) represents a collection of pathological entities that cause compression of the cervical spinal cord, resulting in a clinical syndrome typified by spasticity, hyperreflexia, pathologic reflexes, finger/hand clumsiness, gait disturbance and sphincter dysfunction. In the cervical spine, certain patients are more likely to have myelopathy due to a congenitally narrowed cervical spine canal. Degenerative changes are more common at C5 and C6 or C6 and C7 due to the increased motion at these levels. Additional contributors to canal narrowing are infolding of the ligamentum flavum, olisthesis, osteophytes, and facet hypertrophy. Myelopathy will develop in approximately 100% of patients with canal stenosis greater than 60% (less than 6 mm sagittal disc cord space). Classically it has an insidious onset, progressing in a stepwise manner with functional decline. Without treatment, patients may progress toward significant paralysis and loss of function. Treatment requires surgery with either anterior or posterior decompression of the area of narrowing, and probable fusion. Factors of a poor prognosis include symptoms lasting for more than 18 months, increased range of motion in the cervical spine, and female gender. In this study, we give an overview of the state-of-the-art in DCM, with a focus on the pathophysiology, clinical presentation, differential diagnosis, imaging evaluation, natural history, treatment options and complications. Level of evidence III; Review article.

Use Of Diffusion Tensor Tractography as an Adjunct In The Diagnosis and Support in the Timely Treatment of Degenerative Cervical Myelopathy

“…In cases where ventral cord compression involves a major component of the vertebral body, beyond the limits of the disc, a cervical corpectomy is necessary to adequately decompress the spinal cord, followed by reconstruction and stabilization. An intersomatic device such as titanium, PEEK, allograft or autograft (obtained from the iliac crest or fibula) is used for reconstruction and fusion [28].Certain risks are associated with the Smith-Robinson pág. 11489 approach, regardless of the spinal procedure performed.…”

Cervical Degenerative Myelopathy, Panoramic Review

“…The level of neurological impairment can be measured using the modified Japanese Association Scale (mJOA) or the Nurick grade. Treatment sometimes requires anterior or posterior decompression surgery of the stenosed surface and sometimes fusion (1,4).…”

The Utility of COMPASS-31 Questionnaire to Predict Autonomic Dysfunction in Patients With Cervical/Upper Thoracic Compressive Myelopathy

“…P atients with compressive myelopathy involving the cervical and/or upper thoracic (T1-T4) region often present with pain, radiculopathy, neurological deficits, bladder dysfunction, and symptoms of autonomic dysfunction. 1,2 Compressive myelopathy may be caused by age-related degenerative changes (spondylosis), 3 disc herniation, 4 rheumatoid arthritis, 5 trauma, or tumors. 6 The presence of autonomic dysfunction in patients with chronic compressive myelopathy can be a contributing factor to fluctuations in intraoperative hemodynamics and the associated perioperative complications.…”

“…Patients with compressive myelopathy involving the cervical and/or upper thoracic (T1-T4) region often present with pain, radiculopathy, neurological deficits, bladder dysfunction, and symptoms of autonomic dysfunction 1,2. Compressive myelopathy may be caused by age-related degenerative changes (spondylosis),3 disc herniation,4 rheumatoid arthritis,5 trauma, or tumors 6.…”