Cervical Myelopathy

Introduction

Cervical myelopathy is a clinical syndrome characterized by clumsiness in hands, gait imbalance, and weakness. It is most commonly caused by compression of the spinal cord however other disease processes can result in similar symptoms

Pathophysiology

The most common cause of cervical myelopathy is degenerative cervical spondylosis (CSM). In this condition, compression is usually caused by anterior degenerative changes (osteophytes, discosteophyte complex). Degenerative spondylolithesis may contribute to spinal canal narrowing. Some individuals have underlying congenital stenosis. Symptoms usually begin when congenital narrowing is combined with spondylotic degenerative changes but large disc herniations can also result in enough spinal cord compression to cause myelopathy. Other more rare causes include

• OPLL Ossification of the posterior longitudinal ligament
• tumor
• epidural abscess
• trauma
• cervical kyphosis
• Neurologic injury is often a result of direct cord compression and ischemic injury secondary to compression of spinal vasculature.

Associated conditions

It is important to remember that patients with cervical stenosis are at increased risk for lumbar stenosis.

Prognosis

Cervical myelopathy tends to be slowly progressive and rarely improves with nonoperative modalities. Progression characterized by steplike deterioration with periods of stable symptoms.

Early recognition and surgical treatment prior to spinal cord damage is critical for good clinical outcomes.