Cervical Spondylosis with Myelopathy

About Cervical Spondylosis Myelopathy

Cervical spondylosis is a general term for the degenerative changes that occur with wear and tear of the joints in your neck. Sometimes, this degeneration progresses to the point where your spinal cord or spinal nerves are compressed. Irritation or damage to the spinal cord (myelopathy) in the neck as a result of these degenerative changes is known as cervical spondylotic myelopathy (CSM). Although there are other causes of spinal cord damage, CSM is the most common form of myelopathy in patients over the age of 55.

Any age related changes in the spine, such as disc degeneration, bone spurs, and thickened ligaments are involved. These changes narrow the spinal canal, and eventually impinge on the spinal cord. CSM affects the fibers of the spinal cord that travel to the arms, hands, and legs, which may result in numbness, tingling, or weakness of the extremities and compromise the ability to perform routine tasks.

Common Symptoms of Cervical Spondylosis Myelopathy

Symptoms of cervical spondylotic myelopathy depend on the severity of the condition, as well as the levels of the spinal cord involved. Symptoms may include:

  • Numbness of the hands
  • Loss of hand dexterity
  • Arm and/or hand weakness
  • Leg stiffness
  • Unsteadiness while standing or walking
  • Urinary urgency

The presentation varies between patients, with most demonstrating a slow progress loss of function.  Symptoms may also progress then become stable for a period of time. The natural history of CSM is difficult to define.

Diagnosis of Cervical Spondylotic Myelopathy

Diagnosis of cervical spondylotic myelopathy is tricky due to conditions that produce similar symptoms. The patient’s medical history will need to be discussed and a physical examination will need to be performed. Tests may be ordered to rule out other possible conditions. Some of those tests may be:

  • MRI scan – this is the radiographic test of choice since it clearly defines the areas of spinal cord compression.
  • X-rays – regular X-rays are useful to help define the mechanics of the spine and are involved in the surgical planning, if surgery is considered.
  • Post-myelography computed tomography – these X-rays will provide useful images of the spinal canal and can reveal any bulging discs or bone spurs that may be compressing the nerves or spinal  cord

Treatment for Cervical Spondylotic Myelopathy

Surgical decompression of the spinal cord is the primary treatment for CSM. The goal of this procedure is to prevent symptoms for getting worse. The damage that has already occurred in the spinal cord can heal, but there is no way to determine the extent of healing. The primary goal is to prevent progression of the neurological symptoms.

The exact procedure chosen to decompress the spinal cord depends on each individual patient. Some approaches are anterior (from the front of the neck) while some are posterior (from the back of the neck). Surgery options include:

  • Anterior cervical discectomy and fusion (front of the neck)
  • Anterior cervical corpectomy (front of the neck)
  • Cervical laminectomy (back of the neck)
  • Cervical laminectomy and fusion (back of the neck)
  • Cervical laminoplasty (back of the neck)

There are cases where both an anterior and a posterior approach may be used.