Update of the Natural History, Pathophysiology, and Treatment Strategies of Degenerative Cervical Myelopathy: A Narrative Review

Abstract

Cervical myelopathy is a clinical syndrome resulting in symptoms of neurologic deficits due to prolonged spinal cord compression or ischemia in the cervical spine. Spinal cord compression can be caused by ossification of the posterior longitudinal ligament and hypertrophy of ligamentun flavum in addition to degenerative cervical spondylosis, degenerative disc disease, and progressive cervical kyphosis. Degenerative cervical myelopathy (DCM) is a series of disease entities caused by spinal cord compression by various nontraumatic and non-infectious causes. The pathophysiology of DCM includes spinal cord structure and function abnormalities caused by both static and dynamic factors. Surgical decompression for patients with moderate to severe cervical myelopathy not only inhibits the progression of neurological deterioration, but also improves functional status, pain, and quality of life. However, the role of nonsurgical treatment in patients with mild spinal cord compression is controversial. In general, patients with cervical myelopathies who do not undergo surgery have a poor prognosis. Appropriate surgical treatment is recommended when spinal cord compression is confirmed on image study in patients with reasonable symptoms of cervical myelopathy. The patient's overall health, degree of compression, presence of concurrent cervical radiculopathy, and cervical spine alignment, in addition to lesion location and etiology, should be considered when determining an appropriate surgical procedure. This review covers the updated issues, including pathophysiology, clinical manifestations, differential diagnosis, and available treatments for DCM.

K-line tilt: A novel potential predictive indicator for the effectiveness of conservative cervical spondylotic radiculopathy management

“…Literature indicates that surgical treatment is only considered when the pain is severe, conservative treatment has failed, or muscle weakness and atrophy are evident [23]. However, conclusive evidence to determine the indications for conservative CSR treatment and accurate surgical treatment timing is still lacking in the current clinical practice guidelines [24][25][26]. Therefore, this study explores the relation between cervical sagittal parameters and the e cacy of conservative CSR treatment and reveas that the K-line tilt has a particular predictive effect on the e cacy of conservative treatment, providing a reference for cervical radiculopathy treatment decision.…”

An Algorithmic Roadmap for the Surgical Management of Degenerative Cervical Myelopathy: A Narrative Review

“…Degenerative cervical myelopathy (DCM), a prevalent neurological disorder, exhibits varying prevalence and incidence rates because of the diverse classifications of degenerative processes and pathologies [ 1 ]. It is considered the most common cause of spinal cord dysfunction among adults, with a recent study estimating the prevalence of related hospitalizations of 4.04 per 100,000 person-years [ 1 , 2 ]. The pathophysiology of DCM is multifactorial.…”

“…Cervical spondylosis is an age-associated degeneration of the cervical spine caused by excessive motion and repetitive trauma. Spondylosis begins with degenerative changes in the disk space and adjacent structures, including facet joints, uncovertebral joints, posterior longitudinal ligament, and the ligamentum flavum [ 1 ]. OPLL can also cause spinal cord compression, resulting in myelopathy.…”

Tailor-Made Surgical Strategy for Coexistent Cervical Myelopathy and Bilateral Radiculopathy. Combined Laminoplasty, Laminectomy, and Foraminotomy: Report of Two Cases

“…Only medication or rehabilitation therapy can be considered for patients with non-severe symptoms related to cervical spondylosis [ 2 ]. Meanwhile, surgical management can be considered for patients with cervical spondylosis resistant to non-invasive management [ 3 , 4 ].…”