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Natural History of Cervical Degenerative Disorders

  • John E. O’TooleEmail author
  • Joseph E. Molenda
Chapter

Abstract

Cervical spondylosis is a naturally occurring, age-related phenomenon that can be seen radiologically in 95% of males and 70% of females over the age of 70. It is characterized by degenerative changes affecting the vertebrae, intervertebral discs, facets, and associated ligaments. Starting in the third decade of life, there is a progressive loss of water content of the intervertebral disc that continues with age. This is due to a loss of glycosaminoglycan proteins, which attract molecules of water due to their high molecular weight and overall negative charge, located in the nucleus pulposus. As water molecules leave the nucleus pulposus, this results in a less elastic and more compressible disc that bulges into the spinal canal. At the same time, the vertebral bodies drift toward each other, and the ligamentum flavum and the facet joint capsule fold in dorsally. The combination of these events ultimately decreases the dimensions of the neural foramen and spinal canal. The approximation of the vertebral bodies leads to a reactive process that produces osteophytes around the margins of the disc and at the uncovertebral and facet joints. Radiculopathy in cervical spondylosis is the result of compression either by a hypertrophied facet joint or uncovertebral joints, disc protrusion, spondylotic spurring of the vertebral body, or any combination of these processes. Subacute radiculopathy occurs in patients with pre-existing cervical spondylosis, and these patients often develop symptoms which are polyradicular in nature.

Keywords

Cervical degenerative disorders Cervical spondylosis CSM Myelopathy Risk Cervical Surgery Clinical Surgical 

References

  1. 1.
    Abbed KM, Coumans JV. Cervical radiculopathy: pathophysiology, presentation, and clinical evaluation. Neurosurgery. 2007;60:S28–34.CrossRefGoogle Scholar
  2. 2.
    Baron EM, Young WF. Cervical spondylotic myelopathy: a brief review of its pathophysiology, clinical course, and diagnosis. Neurosurgery. 2007;60:S35–41.CrossRefGoogle Scholar
  3. 3.
    Bednarik J, Kadanka Z, Dusek L, et al. Presymptomatic spondylotic cervical myelopathy: an updated predictive model. Eur Spine J. 2008;17:421–31.CrossRefGoogle Scholar
  4. 4.
    Bednarik J, Kadanka Z, Dusek L, et al. Presymptomatic spondylotic cervical cord compression. Spine (Phila Pa 1976). 2004;29:2260–9.CrossRefGoogle Scholar
  5. 5.
    Bednarík J, Kadanka Z, Vohánka S, et al. The value of somatosensory and motor evoked potentials in pre-clinical spondylotic cervical cord compression. Eur Spine J. 1998;7:493–500.CrossRefGoogle Scholar
  6. 6.
    Bednarik J, Sladkova D, Kadanka Z, et al. Are subjects with spondylotic cervical cord encroachment at increased risk of cervical spinal cord injury after minor trauma? J Neurol Neurosurg Psychiatry. 2011;82:779–81.CrossRefGoogle Scholar
  7. 7.
    Blumenkrantz N, Sylvest J, Asboe-Hansen G. Local low-collagen content may allow herniation of intervertebral disc: biochemical studies. Biochem Med. 1977;18:283–90.CrossRefGoogle Scholar
  8. 8.
    Boogaarts HD, Bartels RH. Prevalence of cervical spondylotic myelopathy. Eur Spine J. 2015;24(Suppl 2):139–41.CrossRefGoogle Scholar
  9. 9.
    Chang H, Song KJ, Kim HY, et al. Factors related to the development of myelopathy in patients with cervical ossification of the posterior longitudinal ligament. J Bone Joint Surg Br. 2012;94:946–9.CrossRefGoogle Scholar
  10. 10.
    Chikuda H, Seichi A, Takeshita K, et al. Acute cervical spinal cord injury complicated by preexisting ossification of the posterior longitudinal ligament: a multicenter study. Spine (Phila Pa 1976). 2011;36:1453–8.CrossRefGoogle Scholar
  11. 11.
    Fehlings MG, Arvin B. Surgical management of cervical degenerative disease: the evidence related to indications, impact, and outcome. J Neurosurg Spine. 2009;11:97–100.CrossRefGoogle Scholar
  12. 12.
    Fehlings MG, Smith JS, Kopjar B, et al. Perioperative and delayed complications associated with the surgical treatment of cervical spondylotic myelopathy based on 302 patients from the AOSpine North America cervical Spondylotic myelopathy study. J Neurosurg Spine. 2012;16:425–32.CrossRefGoogle Scholar
  13. 13.
    Gore DR, Sepic SB, Gardner GM. Roentgenographic findings of the cervical spine in asymptomatic people. Spine (Phila Pa 1976). 1986;11:521–4.CrossRefGoogle Scholar
  14. 14.
    Hadley MN, Reddy SV. Smoking and the human vertebral column: a review of the impact of cigarette use on vertebral bone metabolism and spinal fusion. Neurosurgery. 1997;41:116–24.CrossRefGoogle Scholar
  15. 15.
    Kadaňka Z, Bednařík J, Novotný O, et al. Cervical spondylotic myelopathy: conservative versus surgical treatment after 10 years. Eur Spine J. 2011;20:1533–8.CrossRefGoogle Scholar
  16. 16.
    Kadanka Z, Mares M, Bednaník 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 10-1CrossRefGoogle Scholar
  17. 17.
    Kadanka Z, Mares M, Bednarík J, et al. Predictive factors for spondylotic cervical myelopathy treated conservatively or surgically. Eur J Neurol. 2005;12:55–63.CrossRefGoogle Scholar
  18. 18.
    Karadimas SK, Erwin WM, Ely CG, et al. Pathophysiology and natural history of cervical spondylotic myelopathy. Spine (Phila Pa 1976). 2013;38:S21–36.CrossRefGoogle Scholar
  19. 19.
    Katoh S, Ikata T, Hirai N, et al. Influence of minor trauma to the neck on the neurological outcome in patients with ossification of the posterior longitudinal ligament (OPLL) of the cervical spine. Paraplegia. 1995;33:330–3.PubMedGoogle Scholar
  20. 20.
    Kong LD, Meng LC, Wang LF, et al. Evaluation of conservative treatment and timing of surgical intervention for mild forms of cervical spondylotic myelopathy. Exp Ther Med. 2013;6:852–6.CrossRefGoogle Scholar
  21. 21.
    Kumaresan S, Yoganandan N, Pintar FA, et al. Contribution of disc degeneration to osteophyte formation in the cervical spine: a biomechanical investigation. J Orthop Res. 2001;19:977–84.CrossRefGoogle Scholar
  22. 22.
    Lubelski D, Alvin MD, Nesterenko S, et al. Correlation of quality of life and functional outcome measures for cervical spondylotic myelopathy. J Neurosurg Spine. 2016;24:483–9.CrossRefGoogle Scholar
  23. 23.
    Matsunaga S, Nakamura K, Seichi A, et al. Radiographic predictors for the development of myelopathy in patients with ossification of the posterior longitudinal ligament: a multicenter cohort study. Spine (Phila Pa 1976). 2008;33:2648–50.CrossRefGoogle Scholar
  24. 24.
    Matsunaga S, Sakou T, Taketomi E, et al. Clinical course of patients with ossification of the posterior longitudinal ligament: a minimum 10-year cohort study. J Neurosurg. 2004;100:245–8.PubMedGoogle Scholar
  25. 25.
    Matz PG, Anderson PA, Holly LT, et al. The natural history of cervical spondylotic myelopathy. J Neurosurg Spine. 2009;11:104–11.CrossRefGoogle Scholar
  26. 26.
    Oshima Y, Seichi A, Takeshita K, et al. Natural course and prognostic factors in patients with mild cervical spondylotic myelopathy with increased signal intensity on T2-weighted magnetic resonance imaging. Spine (Phila Pa 1976). 2012;37:1909–13.CrossRefGoogle Scholar
  27. 27.
    Patel AA, Spiker WR, Daubs M, et al. Evidence of an inherited predisposition for cervical spondylotic myelopathy. Spine (Phila Pa 1976). 2012;37:26–9.CrossRefGoogle Scholar
  28. 28.
    Rhee JM, Shamji MF, Erwin WM, et al. Nonoperative management of cervical myelopathy: a systematic review. Spine (Phila Pa 1976). 2013;38:S55–67.CrossRefGoogle Scholar
  29. 29.
    Shimomura T, Sumi M, Nishida K, et al. Prognostic factors for deterioration of patients with cervical spondylotic myelopathy after nonsurgical treatment. Spine (Phila Pa 1976). 2007;32:2474–9.CrossRefGoogle Scholar
  30. 30.
    Sumi M, Miyamoto H, Suzuki T, et al. Prospective cohort study of mild cervical spondylotic myelopathy without surgical treatment. J Neurosurg Spine. 2012;16:8–14.CrossRefGoogle Scholar
  31. 31.
    Wang ZC, Shi JG, Chen XS, et al. The role of smoking status and collagen IX polymorphisms in the susceptibility to cervical spondylotic myelopathy. Genet Mol Res. 2012;11:1238–44.CrossRefGoogle Scholar
  32. 32.
    Wu JC, Chen YC, Liu L, et al. Conservatively treated ossification of the posterior longitudinal ligament increases the risk of spinal cord injury: a nationwide cohort study. J Neurotrauma. 2012;29:462–8.CrossRefGoogle Scholar
  33. 33.
    Wu JC, Ko CC, Yen YS, et al. Epidemiology of cervical spondylotic myelopathy and its risk of causing spinal cord injury: a national cohort study. Neurosurg Focus. 2013;35:E10.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Department of NeurosurgeryRush University Medical CenterChicagoUSA

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