Cervical and Thoracic Spondylotic Myelopathies

Abstract

Spondylotic myelopathies are among the most common disorders of the spine, yet the clinical and treatment approach is far from standardized. This article discusses our current understanding of the epidemiology, pathophysiology, clinical assessment, natural history, and treatment options in degenerative myelopathies of the cervical and thoracic spine. We additionally review diagnostic modalities including imaging modalities of the spine and neurophysiological tools such as electromyography/nerve conduction studies, somatosensory-evoked potentials, and motor-evoked potentials. Assessment instruments that can be used for the assessment of myelopathies are reviewed, including the Japanese Orthopedic Association (JOA) score, modified-JOA scale, Nurick scale, nine-hole peg test, and 30-m walking test. We also review common disorders that mimic spondylotic myelopathies, as well as helpful diagnostic clues in differentiating spondylotic and nonspondylotic myelopathies.

Structural Myelopathies

“…Other diagnostic methods include somatosensory evoked potentials and motor evoked potentials, which have promising data supporting their use. 27 Natural History of Degenerative Myelopathy Patients with degenerative cervical myelopathy typically have a stepwise decline, with periods of stability followed by exacerbation of symptoms; not all patients experience decline, with 20% to 60% of patients experiencing neurologic decline after 3 to 6 years. 6,8 Even in studies in which the modified JOA scale scores either decreased modestly or remained stable at 3 years, patients with degenerative cervical myelopathy who had not undergone surgery reported progressive difficulty with performing activities of daily living.…”

“…The pathophysiology behind the proposed etiology is discussed in the Physical Examination Findings Associated With Degenerative Myelopathies section. Other diagnostic methods include somatosensory evoked potentials and motor evoked potentials, which have promising data supporting their use 27 …”

Impact of multimodal intraoperative neurophysiological monitoring of the spinal cord during spine and spinal cord surgeries

“…A preoperative and 1-week postoperative full neurological examination was performed for all the patients. All patients were evaluated clinically using the Japanese Orthopaedic Association (JOA) score [18]. Data were compared to assess any postoperative neurological deficit.…”

Myelopathy: A Clinical Approach

“…Hyperacute causes typically are due to traumatic cord injury and vascular causes, like hemorrhage or infarction (see articles on Traumatic Spinal Cord Disorders and Vascular Spinal Cord Disorders 9,10 ). Acute and subacute presentations have a broader differential diagnosis, primarily consisting of infectious and inflammatory (rheumatologic, demyelinating diseases, radiation toxicity, or paraneoplastic) etiologies, in addition to progressive structural abnormalities related to a mass or canal stenosis (see articles on Infectious Myelopathies, Immune-Mediated Myelopathies, and Cervical and Thoracic Spondylotic Myelopathies [11][12][13] ). Of the various vascular causes, a spinal dural arteriovenous fistula can present with acute fluctuations over time.…”