Cervical spondylotic myelopathy

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By Saul S Schwarz MD

Cervical spondylotic myelopathy is also known as Cervical spinal stenosis. -ed.

Cervical spondylotic myelopathy is a progressive noninflammatory disease process occurring in middle-aged and elderly patients, predominantly affecting the intervertebral discs and facets joints. Narrowing of the spinal canal by osteophytic spurring produces myelopathy by compression of the spinal cord and radiculopathy by compression of the nerve roots. In this updated clinical summary, Dr. Saul Schwarz of the University of Colorado Health Sciences in Denver, Colorado, presents proper diagnostic criteria, presentation, differential diagnoses, pathophysiology, and treatment options, including the latest imaging criteria and a review of anterior and posterior surgical approaches.

Key Points

  • Cervical spondylotic myelopathy is an arthritic condition affecting the cervical facet joints and discs producing bony ridging in the central canal and neural foramina, resulting in compressive signs and symptoms of spinal cord and nerve root compression.
  • Presenting features may involve a mix of upper and lower motor neuron dysfunction in the arms and hands, and upper motor neuron dysfunction in the legs.
  • The diagnosis is established by combining clinical findings with the imaging characteristics of bony narrowing of the central and lateral aspects of the cervical spinal canal, as seen on MRI and CT.
  • Treatment is directed at controlling arthritic axial neck pain, and surgical decompression with or without fusion is considered if signs and symptoms of myelopathy are present.

In This Article

Historical note and nomenclature
Clinical manifestations
Clinical vignette
Pathogenesis and pathophysiology
Differential diagnosis
Diagnostic workup
Prognosis and complications
References cited