title: Cervical spondylotic myelopathy in the young adult: a review of the literature and clinical diagnostic criteria in an uncommon demographic.
abstract: BACKGROUND
  Cervical spondylotic myelopathy (CSM) is typically encountered in the elderly population. Significant inconsistencies currently exist regarding the definition of the disorder, the true incidence of CSM in younger populations, and the established diagnostic criteria.
  
  
  OBJECTIVE
  To highlight the lack of standardization in the definition and diagnosis of CSM.
  
  
  METHODS
  A PubMed literature search was conducted spanning the years 2001-2011. The search was limited by the following terms: (1) English language, (2) adults (19-44 years old), and (3) "cervical spondylotic myelopathy." Each article was reviewed to determine if the presence of the definition of CSM existed in the article. The clinical characteristics used to make the diagnosis of CSM were recorded for each article. Cochran's Q statistic was used to determine whether some clinical characteristics were more frequently used than others.
  
  
  RESULTS
  Ninety-three papers were reviewed in detail and 16 case reports, reviews, and articles concerning less than 3 patients were excluded, resulting in 77 articles in the final analysis. The most common clinical definitions were gait disturbance (22/77 articles (28.6%)), upper limb paresthesias or sensory disturbance (21/77 (27.3%)), and clumsy hands (15/77 (19.5%)). Hyperreflexia, spasticity, and pathologically increased reflexes were identified as diagnostic criteria in a minority of patients.
  
  
  CONCLUSIONS
  The literature employs a wide range of neurologic signs and symptoms to make the diagnosis of CSM, with a majority of studies failing to rely on strict diagnostic criteria. The clinician should not discount CSM as an explanation for the aforementioned findings, as it is well-reported in the literature among the ages 18-44.
authors.affiliation: Thomas Jefferson University Hospital, 717 S. Columbus Blvd, Unit 607, Philadelphia 19147, USA.
authors.forename: Peter S
authors.initials: PS
authors.lastname: Amenta
authors.affiliation: Thomas Jefferson University Hospital, 717 S. Columbus Blvd, Unit 607, Philadelphia 19147, USA. Electronic address: georgeghobrial@gmail.com.
authors.forename: George M
authors.initials: GM
authors.lastname: Ghobrial
authors.affiliation: Thomas Jefferson University Hospital, 717 S. Columbus Blvd, Unit 607, Philadelphia 19147, USA.
authors.forename: Kelly
authors.initials: K
authors.lastname: Krespan
authors.affiliation: Thomas Jefferson University Hospital, 717 S. Columbus Blvd, Unit 607, Philadelphia 19147, USA.
authors.forename: Phi
authors.initials: P
authors.lastname: Nguyen
authors.affiliation: Thomas Jefferson University Hospital, 717 S. Columbus Blvd, Unit 607, Philadelphia 19147, USA.
authors.forename: Muhammed
authors.initials: M
authors.lastname: Ali
authors.affiliation: Thomas Jefferson University Hospital, 717 S. Columbus Blvd, Unit 607, Philadelphia 19147, USA.
authors.forename: James S
authors.initials: JS
authors.lastname: Harrop
mesh_terms: D000328:Adult; D015897:Comorbidity; D006801:Humans; D013118:Spinal Cord Diseases / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology; D055009:Spondylosis / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology; D055815:Young Adult
keywords: Cervical spondylotic myelopathy; Diagnostic criteria; Gait disturbance; Spasticity