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Cervical Spondylotic Myelopathy - Read Causes, Symptoms & Treatments
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Cervical Spondylotic Myelopathy Overview

The cervical spondylotic myelopathy (CSM) refers to the impaired function of the spinal cord caused by the degenerative changes of the discs and the facet joints in the cervical spine (neck) often seen in adult life. This is the most common disorder occurring due to the compression of the spinal cord and causes dysfunction of the spinal cord. The process which leads to spinal cord compression is the result of arthritis in the neck called as cervical spondylosis.

Cervical Spondylotic Myelopathy

This condition is pretty common among patients above 50 years of age. The age of the onset of CSM varies as per the degree of the congenital spinal canal narrowing.

Causes of Cervical Spondylotic Myelopathy:

Cervical arthritis also called as cervical spondylosis is the main cause of spinal cord compression. The changes in the cervical spine make the spinal canal narrow, leads to thickening of the posterior longitudinal ligament and leads to bone spur formation compress the spinal cord usually at C4-C7 levels. This causes a chronic compression of the spinal cord and the nerve roots, thereby lead to impaired blood flow and the neurological deficit that damages the spinal cord.

Diagnosis of Cervical Spondylotic Myelopathy

The doctor will ask your medical history and examine your neck to look for the symptoms of CSM. Tests for determining the cervical spondylotic myelopathy includes:

  • MRI: The magnetic resonance imaging will create better images of soft tissues which will help the doctor to look for the compression of the spinal cord.
  • X-rays: These studies are useful to look at the alignment of your neck.
  • Myelogram: The doctor may ask you this special type of the computed tomography scan that provides detailed cross-section images showing the size of the spinal canal and the bone spurs. In this test, a color dye is injected before the scan to provide a better outline of the spinal cord.
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Symptoms of Cervical Spondylotic Myelopathy:

This condition causes a variety of signs and symptoms. The initial symptom is gait spasticity and this is followed by the upper extremity numbness and loss of fine motor control in the hands.

Other symptoms of CSM are:

  • Sensory changes in the lower extremities.
  • Pain in the neck, shoulder or subscapular areas.
  • Motor weakness in the extremities.
  • Numbness or parenthesis in the upper extremities.
  • Gait difficulties.
  • Lower motor neuron findings such as atrophy and upper extremity hyporeflexia.
  • Mylepathic or upper motor neuron findings like hyperreflexia, spasticity, Babinkski, clones and Hoffman signs and bowel and bladder dysfunction.
  • Neck pain and stiffness
  • Tingling
  • Weakness

Treatments for Cervical Spondylotic Myelopathy:

There are two different treatments for the cervical spondylotic myelopathy:

  • 1.    Non-surgical Treatment: Some patients get relief from the symptoms without surgery. The most commonly used non-surgical treatment options are:
    • Exercises: It may lessen the discomfort and help to improve the neck strength and flexibility.
    • Soft collars: It allows the muscles of the neck to rest and limit the neck motion. The collars will help to reduce the pinching of the nerve roots with movements. You should wear these soft collars only for short period of time as wearing it for long-term can decrease the strength of the neck muscles.
    • Non-steroidal Anti-Inflammatory medications (NSAIDs): It involves the drugs like ibuprofen and aspirin that help reduce the swelling and pain symptoms.
    • Chiropractic manipulation: The manipulation is never given to the patient having spinal cord compression.
    • Epidural steroid injections: These injections include cortisone, which is a powerful anti-inflammatory given in the epidural area to decrease the pain and swelling. These injections are usually not used in CSM.
  • 2.    Surgical treatments: The goal of the surgical treatments for CSM is to open the space for the spinal cord in order to remove the part of the bone or soft tissues that are pressing the spinal cord.

    There are many successful surgical treatments for CSM. The decompression is either performed from the front of the neck called as anterior approach or the back of the neck called as posterior approach. Both these approaches have advantages as well as disadvantages, so you should discuss about it with your surgeon.
    • A.   Anterior approach: In this surgical approach, the surgeon operates from the front of the neck by creating a one to two inch incision to remove the discs or the bones pressing the spinal cord. This is followed by fusion back together with a bone graft.
      • Anterior cervical diskectomy and fusion: During this procedure, the surgeon removes the problem disc and the left over the area is stretched such that the height is similar to what it was before the disc wear out. A bone graft is placed in the space where the disc is removed.
      • Anterior cervical corpectomy and fusion: This surgical procedure is same as the diskectomy expect that the vertebrae is removed and replaced by the bone graft material. In some cases where both the disc and bone are pressing the spinal cord, a combination of both the procedures may be performed. Spinal fusion is essential while removing the disc to stabilize the spine. This will take away some spinal flexibility and the degree of the fusion depends on the number of spine segments requiring fusion. Metal plates and screws are also used to keep the bones in place.
      • Bone graft: A bone graft material is used to fill the space left after the disc is removed. It is placed along the sides of the vertebrae to support fusion. It is primarily used to stimulate bone healing and this increases the bone growth, which help the vertebrae heal together into a solid bone. You should discuss the benefits, risks for all types of bone grafts with your surgeon.
    • B.   Posterior Approach: This approach includes an incision made along the midline of the back of the neck. Surgical procedures may include the following:
      • Laminectomy: During this procedure, bone spurs, bony arch and ligaments that compress the spinal cord are removed. This will help relieve the pressure on the spinal cord and ensures complete decompression of the spinal cord. This procedure can be performed by combining the fusion with a bone graft and rods and screws.
      • Laminoplasty: This is an alternative to the laminectomy procedure which hinges the lamina open without completely removing the bone. This procedure can expand the spinal canal and allows the surgeon to address the adjacent spine segments.

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