HSS Journal

, Volume 7, Issue 2, pp 170–178 | Cite as

Cervical Spondylotic Myelopathy: Pathophysiology, Clinical Presentation, and Treatment

  • Darren R. Lebl
  • Alex Hughes
  • Frank P. CammisaJr
  • Patrick F. O’Leary
Review Article

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.

Keywords

cervical spine spondylosis myelopathy natural history operative treatment 

References

  1. 1.
    Arnold JG, Jr. The clinical manifestations of spondylochondrosis (spondylosis) of the cervical spine. Ann Surg 1955;141:872–89.PubMedGoogle Scholar
  2. 2.
    Barnes MP, Saunders M. The effect of cervical mobility on the natural history of cervical spondylotic myelopathy. J Neurol Neurosurg Psychiatry 1984;47:17–20.PubMedCrossRefGoogle Scholar
  3. 3.
    Batzdorf U, Batzdorff A. Analysis of cervical spine curvature in patients with cervical spondylosis. Neurosurgery 1988;22:827–36.PubMedCrossRefGoogle Scholar
  4. 4.
    Blackley HR, Plank LD, Robertson PA. Determining the sagittal dimensions of the canal of the cervical spine. The reliability of ratios of anatomical measurements. J Bone Joint Surg Br 1999;81:110–2.PubMedCrossRefGoogle Scholar
  5. 5.
    Boden SD, McCowin PR, Davis DO, et al. Abnormal magnetic-resonance scans of the cervical spine in asymptomatic subjects. A prospective investigation. J Bone Joint Surg Am 1990;72:1178–84.PubMedGoogle Scholar
  6. 6.
    Brain WR, Northfield D, Wilkinson M. The neurological manifestations of cervical spondylosis. Brain 1952;75:187–225.PubMedCrossRefGoogle Scholar
  7. 7.
    Breig A, Turnbull I, Hassler O. Effects of mechanical stresses on the spinal cord in cervical spondylosis. A study on fresh cadaver material. J Neurosurg 1966;25:45–56.PubMedCrossRefGoogle Scholar
  8. 8.
    Brodke DS, Gollogly S, Alexander Mohr R, et al. Dynamic cervical plates: biomechanical evaluation of load sharing and stiffness. Spine 2001; 26:1324–9.PubMedCrossRefGoogle Scholar
  9. 9.
    Brodke DS, Klimo P, Jr., Bachus KN, et al. Anterior cervical fixation: analysis of load-sharing and stability with use of static and dynamic plates. J Bone Joint Surg Am 2006;88:1566–73.PubMedCrossRefGoogle Scholar
  10. 10.
    Chiles BW, 3rd, Leonard MA, Choudhri HF, et al. Cervical spondylotic myelopathy: patterns of neurological deficit and recovery after anterior cervical decompression. Neurosurgery 1999;44:762–9PubMedCrossRefGoogle Scholar
  11. 11.
    Clarke E, Robinson PK. Cervical myelopathy: a complication of cervical spondylosis. Brain 1956;79:483–510.PubMedCrossRefGoogle Scholar
  12. 12.
    Edwards WC, LaRocca H. The developmental segmental sagittal diameter of the cervical spinal canal in patients with cervical spondylosis. Spine (Phila Pa 1976) 1983;8:20–7.Google Scholar
  13. 13.
    Fehlings MG KB, Arnold PM, Yoon ST, Vaccaro AR. Anterior vs Posterior Surgical Approaches to Treat Cervical Spondylotic Myelopathy: Outcomes of the Prospective Multi-center AOSPine North America CSM Study in 280 Patients. Cervical Spine Research Society 38th Annual Meeting 2010:86–8.Google Scholar
  14. 14.
    Fountas KN, Kapsalaki EZ, Nikolakakos LG, et al. Anterior cervical discectomy and fusion associated complications. Spine (Phila Pa 1976) 2007;32:2310–7.Google Scholar
  15. 15.
    Fouyas IP, Statham PF, Sandercock PA. Cochrane review on the role of surgery in cervical spondylotic radiculomyelopathy. Spine (Phila Pa 1976) 2002;27:736–47.Google Scholar
  16. 16.
    Fujiwara K, Yonenobu K, Hiroshima K, et al. Morphometry of the cervical spinal cord and its relation to pathology in cases with compression myelopathy. Spine (Phila Pa 1976) 1988;13:1212–6.Google Scholar
  17. 17.
    Fujiwara K, Yonenobu K, Ebara S, et al. The prognosis of surgery for cervical compression myelopathy. An analysis of the factors involved. J Bone Joint Surg Br 1989;71:393–8.PubMedGoogle Scholar
  18. 18.
    Glaser JA CJ, Bailey KL, Morrow DL. Cervical spinal cord compression and the Hoffman sign. Iowa Ortho J 2001;21:49–51.Google Scholar
  19. 19.
    Goffin J, Geusens E, Vantomme N, et al. Long-term follow-up after interbody fusion of the cervical spine. J Spinal Disord Tech 2004;17:79–85.PubMedCrossRefGoogle Scholar
  20. 20.
    Gore DR, Sepic SB. Anterior discectomy and fusion for painful cervical disc disease. A report of 50 patients with an average follow-up of 21 years. Spine (Phila Pa 1976) 1998;23:2047–51.Google Scholar
  21. 21.
    Hacker RJ. Cervical disc arthroplasty: a controlled randomized prospective study with intermediate follow-up results. Invited submission from the joint section meeting on disorders of the spine and peripheral nerves, March 2005. J Neurosurg Spine 2005;3:424–8.PubMedCrossRefGoogle Scholar
  22. 22.
    Hashimoto M, Mochizuki M, Aiba A, et al. C5 palsy following anterior decompression and spinal fusion for cervical degenerative diseases. Eur Spine J 2010;19:1702–10.PubMedCrossRefGoogle Scholar
  23. 23.
    Hilibrand AS, Carlson GD, Palumbo MA, et al. Radiculopathy and myelopathy at segments adjacent to the site of a previous anterior cervical arthrodesis. J Bone Joint Surg Am 1999;81:519–28.PubMedGoogle Scholar
  24. 24.
    Hosono N, Sakaura H, Mukai Y, et al. A simple performance test for quantifying the severity of cervical myelopathy. J Bone Joint Surg Br 2008;90:1210–3.PubMedCrossRefGoogle Scholar
  25. 25.
    Hukuda SMT, Ogata M, Schichikawa K, Shimomura T. Operations for cervical spondylotic myelopathy: a comparison of the results of anterior and posterior procedures. J Bone Joint Surg Br 1985;67B:609–15.Google Scholar
  26. 26.
    Ito T, Oyanagi K, Takahashi H, et al. Cervical spondylotic myelopathy. Clinicopathologic study on the progression pattern and thin myelinated fibers of the lesions of seven patients examined during complete autopsy. Spine (Phila Pa 1976) 1996;21:827–33.Google Scholar
  27. 27.
    Kadanka Z, Bednarik J, Vohanka S, et al. Conservative treatment versus surgery in spondylotic cervical myelopathy: a prospective randomised study. Eur Spine J 2000;9:538–44.PubMedCrossRefGoogle Scholar
  28. 28.
    Kadanka Z, Mares M, Bednanik J, et al. Approaches to spondylotic cervical myelopathy: conservative versus surgical results in a 3-year follow-up study. Spine (Phila Pa 1976) 2002;27:2205–10; discussion 10–1.Google Scholar
  29. 29.
    Kaneyama S, Sumi M, Kanatani T, et al. Prospective Study and Multivariate Analysis of the Incidence of C5 Palsy After Cervical Laminoplasty. Spine (Phila Pa 1976) 2010.Google Scholar
  30. 30.
    Koyanagi T, Hirabayashi K, Satomi K, et al. Predictability of operative results of cervical compression myelopathy based on preoperative computed tomographic myelography. Spine (Phila Pa 1976) 1993;18:1958–63.Google Scholar
  31. 31.
    Lees F, Turner JW. Natural History and Prognosis of Cervical Spondylosis. Br Med J 1963;2:1607–10.PubMedCrossRefGoogle Scholar
  32. 32.
    Matsumoto M, Toyama Y, Ishikawa M, et al. Increased signal intensity of the spinal cord on magnetic resonance images in cervical compressive myelopathy. Does it predict the outcome of conservative treatment? Spine (Phila Pa 1976) 2000;25:677–82.Google Scholar
  33. 33.
    Matsumoto M, Watanabe K, Tsuji T, et al. Risk factors for closure of lamina after open-door laminoplasty. J Neurosurg Spine 2008;9:530–7.PubMedCrossRefGoogle Scholar
  34. 34.
    Matz PG, Anderson PA, Holly LT, et al. The natural history of cervical spondylotic myelopathy. J Neurosurg Spine 2009;11:104–11.PubMedCrossRefGoogle Scholar
  35. 35.
    Mikawa Y, Shikata J, Yamamuro T. Spinal deformity and instability after multilevel cervical laminectomy. Spine (Phila Pa 1976) 1987;12:6–11.Google Scholar
  36. 36.
    Morishita Y, Naito M, Hymanson H, et al. The relationship between the cervical spinal canal diameter and the pathological changes in the cervical spine. Eur Spine J 2009;18:877–83.PubMedCrossRefGoogle Scholar
  37. 37.
    Muhle C, Weinert D, Falliner A, et al. Dynamic changes of the spinal canal in patients with cervical spondylosis at flexion and extension using magnetic resonance imaging. Invest Radiol 1998;33:444–9.PubMedCrossRefGoogle Scholar
  38. 38.
    Nurick S. The pathogenesis of the spinal cord disorder associated with cervical spondylosis. Brain 1972;95:87–100.PubMedCrossRefGoogle Scholar
  39. 39.
    Ogino H, Tada K, Okada K, et al. Canal diameter, anteroposterior compression ratio, and spondylotic myelopathy of the cervical spine. Spine (Phila Pa 1976) 1983;8:1–15.Google Scholar
  40. 40.
    Ohnari H, Sasai K, Akagi S, et al. Investigation of axial symptoms after cervical laminoplasty, using questionnaire survey. Spine J 2006;6:221–7.PubMedCrossRefGoogle Scholar
  41. 41.
    Oshima Y TK, Seichi A, Morii J, Chikuda H, Kawaguchi H, Nakaura K. Natural Course and Prognostic Factors for Mild Cervical Spondylotic Myelopathy. Cervical Spine Research Society 2010;38th Annual Meeting:83.Google Scholar
  42. 42.
    Pavlov H, Torg JS, Robie B, et al. Cervical spinal stenosis: determination with vertebral body ratio method. Radiology 1987;164:771–5.PubMedGoogle Scholar
  43. 43.
    Payne EE, Spillane JD. The cervical spine; an anatomico-pathological study of 70 specimens (using a special technique) with particular reference to the problem of cervical spondylosis. Brain 1957;80:571–96.PubMedCrossRefGoogle Scholar
  44. 44.
    Porchet F, Metcalf NH. Clinical outcomes with the Prestige II cervical disc: preliminary results from a prospective randomized clinical trial. Neurosurg Focus 2004;17:E6.PubMedCrossRefGoogle Scholar
  45. 45.
    Regan CM DGD, Lim MR. Cervical Spine Research Society, 38th Annual Meeting. Paper # 60 2010:199.Google Scholar
  46. 46.
    Riew KD, Buchowski JM, Sasso R, et al. Cervical disc arthroplasty compared with arthrodesis for the treatment of myelopathy. J Bone Joint Surg Am 2008;90:2354–64.PubMedCrossRefGoogle Scholar
  47. 47.
    Roberts A. Myelopathy due to cervical spondylosios treated by collar immobilization. Neurology 1966;16:951–4.Google Scholar
  48. 48.
    Robertson JT, Papadopoulos SM, Traynelis VC. Assessment of adjacent-segment disease in patients treated with cervical fusion or arthroplasty: a prospective 2-year study. J Neurosurg Spine 2005;3:417–23.PubMedCrossRefGoogle Scholar
  49. 49.
    Sadasivan KK, Reddy RP, Albright JA. The natural history of cervical spondylotic myelopathy. Yale J Biol Med 1993;66:235–42.PubMedGoogle Scholar
  50. 50.
    Sekhon LH. Two-level artificial disc placement for spondylotic cervical myelopathy. J Clin Neurosci 2004;11:412–5.PubMedCrossRefGoogle Scholar
  51. 51.
    Sekhon LH. Cervical arthroplasty in the management of spondylotic myelopathy: 18-month results. Neurosurg Focus 2004;17:E8.PubMedCrossRefGoogle Scholar
  52. 52.
    Shin JJ. Intramedullary high signal intensity and neurological status as prognostic factors in cervical spondylotic myelopathy. Acta Neurochir (Wien) 2010;152(10):1687–94.CrossRefGoogle Scholar
  53. 53.
    Smith MD, Emery SE, Dudley A, et al. Vertebral artery injury during anterior decompression of the cervical spine. A retrospective review of ten patients. J Bone Joint Surg Br 1993;75:410–5.PubMedGoogle Scholar
  54. 54.
    Stark RJ, Kennard C, Swash M. Hand wasting in spondylotic high cord compression: an electromyographic study. Ann Neurol 1981;9:58–62.PubMedCrossRefGoogle Scholar
  55. 55.
    Wolf BS, Khilnani M, Malis L. The sagittal diameter of the bony cervical spinal canal and its significance in cervical spondylosis. J Mt Sinai Hosp N Y 1956;23:283–92.PubMedGoogle Scholar
  56. 56.
    Yonenobu K, Hosono N, Iwasaki M, et al. Neurologic complications of surgery for cervical compression myelopathy. Spine (Phila Pa 1976) 1991;16:1277–82.Google Scholar

Copyright information

© Hospital for Special Surgery 2011

Authors and Affiliations

  • Darren R. Lebl
    • 1
    • 3
  • Alex Hughes
    • 2
    • 3
  • Frank P. CammisaJr
    • 2
    • 3
  • Patrick F. O’Leary
    • 2
    • 3
  1. 1.Spine and Scoliosis Surgery, The Hospital For Special SurgeryNew YorkUSA
  2. 2.The Spine Surgery Service, Spine Care Insititute, The Hospital for Special SurgeryNew YorkUSA
  3. 3.Weill Cornell Medical CollegeNew YorkUSA

Personalised recommendations