CERVICAL SPONDYLOTIC MYELOPATHY: A BRIEF REVIEW OF ITS PATHOPHYSIOLOGY, CLINICAL COURSE, AND DIAGNOSIS

DEGENERATIVE DISEASE OF the cervical spine commonly occurs in the natural process of aging. This can lead to compression of the spinal cord and symptomatic myelopathy. We review the pathophysiological factors that lead to myelopathy and the controversial natural history of untreated myelopathy. Signs and symptoms at presentation, examination findings, differential diagnosis, and diagnostic studies are also discussed.

[1]  B. Hart,et al.  Cervical stenosis, spondylosis, and herniated disc disease. , 1991, Radiologic clinics of North America.

[2]  Jonathan J Ross,et al.  Diagnosis of nerve root compression. Myelography, computed tomography, and MRI. , 1992, The Orthopedic clinics of North America.

[3]  K. Fountoulakis,et al.  Neurophysiological investigation of cervical spondylosis. , 2001, Electromyography and clinical neurophysiology.

[4]  R. Schneider,et al.  The syndrome of acute central cervical spinal cord injury; with special reference to the mechanisms involved in hyperextension injuries of cervical spine. , 1954, Journal of neurosurgery.

[5]  M. Roberts,et al.  Quality of Life Assessment with the Medical Outcomes Study Short Form-36 among Patients with Cervical Spondylotic Myelopathy , 2003, Neurosurgery.

[6]  W. Hanafee,et al.  Asymptomatic degenerative disk disease and spondylosis of the cervical spine: MR imaging. , 1987, Radiology.

[7]  J. T. Bennett,et al.  Lower Cervical Spondylosis and Myelopathy in Adults with Down's Syndrome , 1988, Spine.

[8]  S. Nurick.  The natural history and the results of surgical treatment of the spinal cord disorder associated with cervical spondylosis. , 1972, Brain : a journal of neurology.

[9]  R. R. Smith,et al.  Myelopathic cervical spondylotic lesions demonstrated by magnetic resonance imaging. , 1988, Journal of neurosurgery.

[10]  D. Phillips.  Surgical treatment of myelopathy with cervical spondylosis , 1973, Journal of neurology, neurosurgery, and psychiatry.

[11]  W. Yue,et al.  The Torg–Pavlov Ratio in Cervical Spondylotic Myelopathy: A Comparative Study Between Patients With Cervical Spondylotic Myelopathy and a Nonspondylotic, Nonmyelopathic Population , 2001, Spine.

[12]  Shunichi Kawano,et al.  Mechanism of the spinal cord injury and the cervical spondylotic myelopathy: new approach based on the mechanical features of the spinal cord white and gray matter. , 2003, Journal of neurosurgery.

[13]  R. Brower,et al.  Cervical spondylotic myelopathy. Clinical syndrome and natural history. , 1992, The Orthopedic clinics of North America.

[14]  D. Fishbain,et al.  Chronic Cervical Pain: Radiculopathy or Brachialgia: Noninterventional Treatment , 1992, Spine.

[15]  Jumah Kb,et al.  Relationship between load carrying on the head and cervical spondylosis in Ghanaians. , 1994 .

[16]  W. Parke.  Correlative Anatomy of Cervical Spondylotic Myelopathy , 1988, Spine.

[17]  Blumhardt Ld,et al.  A prospective survey of the causes of non-traumatic spastic paraparesis and tetraparesis in 585 patients , 1997 .

[18]  M. Tinetti.  Instability and Falling in Elderly Patients , 1989, Seminars in neurology.

[19]  W. Brown,et al.  Hand Wasting Due to Mid-Cervical Spinal Cord Compression , 1987, Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques.

[20]  W. Young,et al.  Cervical spondylotic myelopathy: a common cause of spinal cord dysfunction in older persons. , 2000, American family physician.

[21]  L. Dušek,et al.  Approaches to Spondylotic Cervical Myelopathy: Conservative Versus Surgical Results in a 3-year Follow-up Study , 2002, Spine.

[22]  J. Epstein.  The Surgical Management of Cervical Spinal Stenosis, Spondylosis, and Myeloradiculopathy by Means of the Posterior Approach , 1988, Spine.

[23]  L. Symon,et al.  The surgical treatment of cervical spondylotic myelopathy , 1967, Neurology.

[24]  S. Nurjck.  The pathogenesis of the spinal cord disorder associated with cervical spondylosis. , 1972 .

[25]  J. Spillane,et al.  The diagnosis of lesions of the spinal cord in association with osteoarthritic disease of the cervical spine. , 1952, Brain : a journal of neurology.

[26]  M. Fehlings,et al.  A Review of the Pathophysiology of Cervical Spondylotic Myelopathy With Insights for Potential Novel Mechanisms Drawn From Traumatic Spinal Cord Injury , 1998, Spine.

[27]  P. K. Robinson,et al.  Cervical myelopathy: a complication of cervical spondylosis. , 1956, Brain : a journal of neurology.

[28]  Sherk.  The Cervical spine , 1983 .

[29]  Jahnke Rw,et al.  Cervical stenosis, spondylosis, and herniated disc disease. , 1991 .

[30]  J. Doppman.  The Mechanism of Ischemia in Anteroposterior Compression of the Spinal Cord , 1975, Investigative radiology.

[31]  John D. Davis,et al.  Outcome of patients treated for cervical myelopathy. A prospective, multicenter study with independent clinical review. , 2000, Spine.

[32]  J. Bednařík,et al.  The value of somatosensory- and motor-evoked potentials in predicting and monitoring the effect of therapy in spondylotic cervical myelopathy. Prospective randomized study. , 1999, Spine.

[33]  R. Schneider,et al.  THE SYNDROME OF ACUTE CENTRAL CERVICAL SPINAL CORD INJURY , 1958, Journal of neurology, neurosurgery, and psychiatry.

[34]  E. Oldfield,et al.  Vascular malformations of the spinal cord and dura. , 1990, Neurosurgery clinics of North America.

[35]  V. Puri,et al.  Syringomyelia-like manifestation of subacute combined degeneration , 2004, Journal of Clinical Neuroscience.

[36]  J. Stambough,et al.  Radiographic evaluation of the degenerative cervical spine. , 1992, The Orthopedic clinics of North America.

[37]  E. Benzel,et al.  Cervical laminectomy and dentate ligament section for cervical spondylotic myelopathy. , 1991, Journal of spinal disorders.

[38]  W. Mcdonald,et al.  Demyelination and remyelination after acute spinal cord compression. , 1973, Experimental neurology.

[39]  Leslie J. Crofford,et al.  Primer on the Rheumatic Diseases , 1999 .

[40]  V. Halbach,et al.  Vascular myelopathies-vascular malformations of the spinal cord: presentation and endovascular surgical management. , 2002, Seminars in neurology.

[41]  Massimiliano Valeriani,et al.  Somatosensory evoked potentials in the diagnosis of cervical spondylotic myelopathy. , 1992, Electromyography and clinical neurophysiology.

[42]  J. Denno,et al.  Early Diagnosis of Cervical Spondylotic Myelopathy: A Useful Clinical Sign , 1991, Spine.

[43]  H. Larocca.  Cervical Spondylotic Myelopathy: Natural History , 1988, Spine.

[44]  L. Brain.  The Nervous System , 1963, Nature.

[45]  Kazuo Yonenobu,et al.  Interobserver and Intraobserver Reliability of the Japanese Orthopaedic Association Scoring System for Evaluation of Cervical Compression Myelopathy , 2001, Spine.

[46]  L Penning,et al.  CT myelographic findings in degenerative disorders of the cervical spine: clinical significance. , 1986, AJR. American journal of roentgenology.

[47]  L. Blumhardt,et al.  A prospective survey of the causes of non-traumatic spastic paraparesis and tetraparesis in 585 patients , 1997, Spinal Cord.

[48]  Edward C Benzel,et al.  Cervical spondylotic myelopathy: make the difficult diagnosis, then refer for surgery. , 2003, Cleveland Clinic journal of medicine.

[49]  A. Steck,et al.  Diagnosis of amyotrophic lateral sclerosis , 1991, Annals of neurology.

[50]  C. Wilson,et al.  Experimental cervical myelopathy. Effects of ischemia and compression of the canine cervical spinal cord. , 1975, Journal of neurosurgery.

[51]  Raj D. Rao.  Neck pain, cervical radiculopathy, and cervical myelopathy: pathophysiology, natural history, and clinical evaluation. , 2002, The Journal of bone and joint surgery. American volume.

[52]  C. Clark.  Cervical Spondylotic Myelopathy: History and Physical Findings , 1988, Spine.

[53]  Volker K. H. Sonntag,et al.  Principles of spinal surgery , 1996 .

[54]  N Yoganandan,et al.  Contribution of disc degeneration to osteophyte formation in the cervical spine: a biomechanical investigation , 2001, Journal of orthopaedic research : official publication of the Orthopaedic Research Society.

[55]  M. Wilkinson.  The morbid anatomy of cervical spondylosis and myelopathy. , 1960, Brain : a journal of neurology.

[56]  Anoushka Singh,et al.  Quantitative assessment of cervical spondylotic my elopathy by a simple walking test , 1999, The Lancet.

[57]  J. Turner,et al.  Natural History and Prognosis of Cervical Spondylosis , 1963, British medical journal.

[58]  P. Weinstein,et al.  Cervical spondylosis. An update. , 1996, The Western journal of medicine.

[59]  F. Walshe.  Syringomyelia , 1927 .

[60]  S. Emery,et al.  Cervical Spondylotic Myelopathy: Diagnosis and Treatment , 2001, The Journal of the American Academy of Orthopaedic Surgeons.

[61]  K. Ikeda,et al.  Association of transforming growth factor beta1 genotype with spinal osteophytosis in Japanese women. , 2000, Arthritis and rheumatism.

[62]  R. Lovelace,et al.  Spastic paraplegia-paraparesis A reappraisal , 1980, Journal of the Neurological Sciences.

[63]  R. R. Smith,et al.  Experimental chronic compressive cervical myelopathy. , 1993, Journal of neurosurgery.

[64]  P. Cooper,et al.  Cervical spondylotic myelopathy: patterns of neurological deficit and recovery after anterior cervical decompression. , 1999, Neurosurgery.

[65]  K. Ragnarsson,et al.  Sudden quadriplegia after a minor trauma. The role of preexisting spinal stenosis. , 1985, Surgical neurology.

[66]  P. Sandercock,et al.  Cochrane Review on the Role of Surgery in Cervical Spondylotic Radiculomyelopathy , 2002, Spine.

[67]  K. Yonenobu,et al.  Canal Diameter, Anteroposterior Compression Ratio, and Spondylotic Myelopathy of the Cervical Spine , 1983, Spine.

[68]  J. Munro.  Macleod's Clinical Examination , 1990 .

[69]  K. Shichikawa,et al.  Operations for cervical spondylotic myelopathy. A comparison of the results of anterior and posterior procedures. , 1985, The Journal of bone and joint surgery. British volume.

[70]  B. Mishra,et al.  Surgical outcome in patients with coexisting multiple sclerosis and spondylosis , 1999, Acta neurologica Scandinavica.

[71]  T. Origitano,et al.  Familial cervical spondylosis. Case report. , 1998, Journal of neurosurgery.

[72]  P. Nyame,et al.  Relationship between load carrying on the head and cervical spondylosis in Ghanaians. , 1994, West African journal of medicine.

[73]  M. Hadley,et al.  Smoking and the human vertebral column: a review of the impact of cigarette use on vertebral bone metabolism and spinal fusion. , 1998, Neurosurgery.

[74]  W. Broaddus,et al.  Hyperactive pectoralis reflex as an indicator of upper cervical spinal cord compression. Report of 15 cases. , 1997, Journal of neurosurgery.

[75]  K. Yonenobu,et al.  Myelopathy Hand Characterized by Muscle Wasting: A Different Type of Myelopathy Hand in Patients with Cervical Spondylosis , 1988, Spine.

[76]  K. Yonenobu,et al.  Myelopathy hand. New clinical signs of cervical cord damage. , 1987, The Journal of bone and joint surgery. British volume.

[77]  B. Kendall,et al.  Identifiable causes for poor outcome in surgery for cervical spondylosis , 1990, Neuroradiology.

[78]  J. Heller.  The syndromes of degenerative cervical disease. , 1992, The Orthopedic clinics of North America.