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Cervical Spondylotic Myelopathy: Pathophysiology, Clinical Presentation, and Treatment

  • Review Article
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HSS Journal ®

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.

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Authors and Affiliations

  1. Spine and Scoliosis Surgery, The Hospital For Special Surgery, 535 East 70th Street, New York, NY, 10021, USA

    Darren R. Lebl MD

  2. The Spine Surgery Service, Spine Care Insititute, The Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA

    Alex Hughes MD, Frank P. Cammisa Jr MD & Patrick F. O’Leary MD

  3. Weill Cornell Medical College, New York, NY, 10065, USA

    Darren R. Lebl MD, Alex Hughes MD, Frank P. Cammisa Jr MD & Patrick F. O’Leary MD

Authors
  1. Darren R. Lebl MD
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  2. Alex Hughes MD
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  3. Frank P. Cammisa Jr MD
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  4. Patrick F. O’Leary MD
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Correspondence to Darren R. Lebl MD.

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Each author certifies that he or she has no commercial associations (e.g., consultancies, stock ownership, equity interest, patent/licensing arrangements, etc.) that might pose a conflict of interest in connection with the submitted article.

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Lebl, D.R., Hughes, A., Cammisa, F.P. et al. Cervical Spondylotic Myelopathy: Pathophysiology, Clinical Presentation, and Treatment. HSS Jrnl 7, 170–178 (2011). https://doi.org/10.1007/s11420-011-9208-1

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  • DOI: https://doi.org/10.1007/s11420-011-9208-1

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