Cervical Spondylotic Myelopathy

Cervical spondylotic myelopathy (CSM) refers to impaired function of the spinal cord caused by degenerative changes of the discs and facet joints acquired in adult life. This is the most common disorder causing dysfunction of the spinal cord in the United States. Most patients with this condition are over 50 years of age, but the age of onset is variable, depending on the degree of congenital spinal canal narrowing.

Cervical Spondylotic Myelopathy Causes

The process that leads to spinal cord compression is a result of cervical "arthritis" (also called cervical spondylosis). Changes in the cervical spine produce narrowing of the spinal canal itself, leading to thickening of the posterior longitudinal ligament and bone spur (osteophyte) formation compressing the spinal cord, most commonly at the C4-C7 levels. The end result is chronic compression of the spinal cord and nerve roots leading to impaired blood flow and neurological deficit and resulting in damage within the spinal cord itself.

Cervical Spondylotic Myelopathy Symptoms

Cervical spondylotic myelopathy causes a variety of signs and symptoms. The first sign is commonly gait spasticity, followed by upper extremity numbness and loss of fine motor control in the hands.

Other symptoms of cervical spondylotic myelopathy include:

  • Pain in the neck, subscapular area, or shoulder
  • Numbness or paresthesia in the upper extremities
  • Sensory changes in the lower extremities
  • Motor weakness in the extremities
  • Gait difficulties ("spastic gait," hesitant and jerky)
  • Myelopathic or "upper motor neuron" findings such as spasticity, hyperreflexia, clonus, Babinski, and Hoffman signs, and bowel and bladder dysfunction
  • "Lower motor neuron" findings such as upper extremity hyporeflexia and atrophy

Who is a typical cervical spondylotic myelopathy patient?

Most cervical spondylotic myelopathy patients are over 50 years old.

Diagnosing Cervical Spondylotic Myelopathy

The diagnosis of cervical myelopathy depends on the patient's history and the physical findings described above. It may then be confirmed by radiologic imaging, such as an MRI scan of the cervical spine demonstrating overt spinal cord and nerve root compression. A cervical CT myelogram may aid in determination of the anatomy associated with nerve root and spinal cord compression.

Surgical Treatment of Cervical Spondylotic Myelopathy

Some of the surgical procedures used to treat cervical spondylotic myelopathy at Emory are: