Cervical Spondylotic Myelopathy

Abstract

Cervical spondylotic myelopathy (CSM) is a common disorder involving chronic progressive compression of the cervical spinal cord due to degenerative disc disease, spondylosis, or other degenerative pathology. CSM is the most common form of spinal cord impairment and causes functional decline leading to reduced independence and quality of life. Despite a sound understanding of the disease process, clinical presentation and management, a universal definition of CSM and a standardized index of severity are not currently used universally. Work is required to develop a definition and establish clinical predictors of progression to improve management of CSM. Despite advances in decompressive and reconstructive surgery, patients are often left with residual disability. Gaps in knowledge of the pathobiology of CSM have limited therapeutic advances to complement surgery. Although the histopathologic and pathophysiologic similarities between CSM and traumatic spinal cord injury have long been acknowledged, the unique pathomechanisms of CSM remain unexplored. Increased efforts to elucidate CSM pathobiology could lead to the discovery of novel therapeutic targets for human CSM and other spinal cord diseases. Here, the natural history of CSM, epidemiology, clinical presentation, and current methods of clinical management are reported, along with the current state of basic scientific research in the field.

Predictors of symptomatic myelopathy in degenerative cervical spinal cord compression

“…Symptoms, especially gait disturbance and loss of sensation, are the most commonly identified presenting symptoms (Kalsi‐Ryan et al., 2013), and our findings are similar. Myelopathic signs, although necessary for confirmation of myelopathic origin of otherwise unspecific symptoms, such as gait disturbance, are usually a hallmark of more advanced stage of myelopathy.…”

“…Although previously used diagnostic criteria for DCM were neither standardized nor consistent across published studies, recent and current studies have defined DCM by the presence of at least one neurological sign and at least one neurological symptom in addition to a positive MRI for compression of the cord (Amenta et al., 2014; Kalsi‐Ryan, Karamidas, & Fehlings, 2013). …”

“…In general, spinal cord compression can be described based on the appearance or by measuring a ratio between the anteroposterior diameter at the compressed site and that of a noncompressed site, a ratio between the anteroposterior diameter and the transverse diameter (i.e., CR), or CSA at the region of compression (Nouri, Martin, Mikulis, & Fehlings, 2016). MRI T1/T2 signal changes, although frequently detected in DCM, are neither sensitive nor specific for degenerative cervical cord compression and are invaluable to the diagnosis of DCM (Kalsi‐Ryan et al., 2013; Wilson et al., 2013). Regardless of the method used, the objective of especially quantitative measurements is to determine the severity of spinal cord compression rather than to detect especially subtle focal compressions.…”

“…Myelopathic signs, although necessary for confirmation of myelopathic origin of otherwise unspecific symptoms, such as gait disturbance, are usually a hallmark of more advanced stage of myelopathy. Assessment tools to better define and document impairment and function quantitatively will be useful in identifying the actual clinical presentation and the impact on independence for these individuals (Kalsi‐Ryan et al., 2013). Quantified walk and run are definitely among those assessment tools.…”

The differential diagnosis of thoracic outlet syndrome

“…Servikal miyelopati; vertebraların osteoartriti, ya da geniş tabanlı posterior disk hernisi sonucu spinal kord basısı sonucu ortaya çıkan klinik tablodur (24). Kola yayılan boyun ve omuz ağrısı, üst ekstremitede miyotomal dağılımlı güçsüzlük, atrofi, reflekslerde azalma yanında, alt ekstremitelerde güç kaybı ve üst motor nöron bulguları reflekslerde artış, Babinski pozitifliği saptanabilir.…”