Cervical Spondylotic Myelopathy: Pathophysiology, Clinical Presentation, and Treatment

Darren R. Lebl, MD
Spine and Scoliosis Surgery, Hospital for Special Surgery
Weill Cornell Medical College


Alexander P. Hughes, MD

Assistant Attending Orthopedic Surgeon

Frank P. Cammisa Jr., MD

Chief of the Spine Service, Hospital for Special Surgery
Professor of Surgery (Orthopaedics), Weill Cornell Medical College

Patrick F. O'Leary, MD, FACS, PC

Associate Attending Orthopaedic Surgeon, Hospital for Special Surgery
Associate Professor of Orthopedic Surgery, Weill Cornell Medical College

Abstract

Age-related changes in the spinal column result in a degenerative cascade known as spondylosis. Genetic, environmental, and occupational influences may play a role. These spondylotic changes may result in direct compressive and ischemic dysfunction of the spinal cord known as cervical spondylotic myelopathy (CSM). Both static and dynamic factors contribute to the pathogenesis. CSM may present as subclinical stenosis or may follow a more pernicious and progressive course. Most reports of the natural history of CSM involve periods of quiescent disease with intermittent episodes of neurologic decline. If conservative treatment is chosen for mild CSM, close clinical and radiographic follow-up should be undertaken in addition to precautions for trauma-related neurologic sequelae. Operative treatment remains the standard of care for moderate to severe CSM and is most effective in preventing the progression of disease. Anterior surgery is often beneficial in patients with stenotic disease limited to a few segments or in cases in which correction of a kyphotic deformity is desired. Posterior procedures allow decompression of multiple segments simultaneously provided that adequate posterior drift of the cord is attainable from areas of anterior compression. Distinct risks exist with both anterior and posterior surgery and should be considered in clinical decision-making.

This article appears in HSS Journal: Volume 7, Number 2.
View the full article at springerlink.com.

About the HSS Journal
HSS Journal, an academic peer-reviewed journal, is published twice a year, February and September, and features articles by internal faculty and HSS alumni that present current research and clinical work in the field of musculoskeletal medicine performed at HSS, including research articles, surgical procedures, and case reports.


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