Article

Cervical Spondylotic Myelopathy: Pathophysiology, Clinical Presentation, and Treatment

Spine and Scoliosis Surgery, The Hospital For Special Surgery, 535 East 70th Street, New York, NY 10021, USA; The Spine Surgery Service, Spine Care Insititute, The Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA; Weill Cornell Medical College, New York, NY 10065, USA
HSS Journal 01/2011; 7(2):170-178. DOI: 10.1007/s11420-011-9208-1

ABSTRACT Age-related changes in the spinal column result in a degenerative cascade known as spondylosis. Genetic, environmental, and
occupational influences may play a role. These spondylotic changes may result in direct compressive and ischemic dysfunction
of the spinal cord known as cervical spondylotic myelopathy (CSM). Both static and dynamic factors contribute to the pathogenesis.
CSM may present as subclinical stenosis or may follow a more pernicious and progressive course. Most reports of the natural
history of CSM involve periods of quiescent disease with intermittent episodes of neurologic decline. If conservative treatment
is chosen for mild CSM, close clinical and radiographic follow-up should be undertaken in addition to precautions for trauma-related
neurologic sequelae. Operative treatment remains the standard of care for moderate to severe CSM and is most effective in
preventing the progression of disease. Anterior surgery is often beneficial in patients with stenotic disease limited to a
few segments or in cases in which correction of a kyphotic deformity is desired. Posterior procedures allow decompression
of multiple segments simultaneously provided that adequate posterior drift of the cord is attainable from areas of anterior
compression. Distinct risks exist with both anterior and posterior surgery and should be considered in clinical decision-making.

Keywordscervical spine–spondylosis–myelopathy–natural history–operative treatment

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