Cervical spondylotic myelopathy.
BACKGROUND
Cervical spondylosis is part of the aging process and affects most people if they live long enough. Degenerative changes affecting the intervertebral disks, vertebrae, facet joints, and ligamentous structures encroach on the cervical spinal canal and damage the spinal cord, especially in patients with a congenitally small cervical canal. Cervical spondylotic myelopathy (CSM) is the most common cause of myelopathy in adults.


RESULTS
The anatomy, pathophysiology, clinical presentation, differential diagnosis, diagnostic investigation, natural history, and treatment options for CSM are summarized. Patients present with signs and symptoms of cervical spinal cord dysfunction with or without cervical nerve root injury. The condition may or may not be accompanied by pain in the neck and/or upper limb. The differential diagnosis is broad. Imaging, typically with magnetic resonance imaging, is the most useful diagnostic tool. Electrophysiologic testing can help exclude alternative diagnoses. The effectiveness of conservative treatments is unproven. Surgical decompression improves neurologic function in some patients and prevents worsening in others, but is associated with risk.


CONCLUSIONS
Neurologists should be familiar with this very common condition. Patients with mild signs and symptoms of CSM can be monitored. Surgical decompression from an anterior or posterior approach should be considered in patients with progressive and moderate to severe neurologic deficits.
Tracy
Jennifer A
JA
Department of Neurology, Mayo Clinic, Rochester, MN 55905, USA.
Bartleson
J D
JD
D002574:Cervical Vertebrae / Q000473:pathology* / Q000503:physiopathology* / Q000601:surgery; D019299:Decompression, Surgical / Q000009:adverse effects / Q000379:methods / Q000592:standards; D003952:Diagnostic Imaging; D003943:Diagnostic Techniques, Neurological; D006801:Humans; D019635:Neurosurgical Procedures / Q000009:adverse effects / Q000379:methods / Q000592:standards; D011183:Postoperative Complications / Q000209:etiology / Q000503:physiopathology; D018570:Risk Assessment; D013116:Spinal Cord / Q000473:pathology / Q000503:physiopathology / Q000601:surgery; D013117:Spinal Cord Compression / Q000175:diagnosis* / Q000503:physiopathology* / Q000601:surgery; D055009:Spondylosis / Q000150:complications / Q000175:diagnosis* / Q000503:physiopathology*