Pathophysiology of cervical myelopathy (Review)

Cervical myelopathy is a well-described medulla spinalis syndrome characterized by sensory disorders, such as pain, numbness, or paresthesia in the limbs, and motor disorders, such as muscle weakness, gait difficulties, spasticity, or hyperreflexia. If left untreated, cervical myelopathy can significantly affect the quality of life of patients, while in severe cases, it can cause disability or even quadriplegia. Cervical myelopathy is the final stage of spinal cord insult and can result from transgene dysplasias of the spinal cord, and acute or chronic injuries. Spondylosis is a common, multifactor cause of cervical myelopathy and affects various elements of the spine. The development of spondylotic changes in the spine is gradual during the patient's life and the symptoms are presented at a late stage, when significant damage has already been inflicted on the spinal cord. Spondylosis is widely considered a condition affecting the middle aged and elderly. Given the fact that the population is gradually becoming older, in the near future, clinicians may have to face an increased number of patients with spondylotic myelopathy.

[1]  B. Davies,et al.  Human spinal cord tissue is an underutilised resource in degenerative cervical myelopathy: findings from a systematic review of human autopsies , 2023, Acta Neurochirurgica.

[2]  Maddison McClellan,et al.  Cervical Spondylotic Myelopathy , 2023, Contemporary Spine Surgery.

[3]  Abhirup Das,et al.  Degenerative Cervical Myelopathy: Insights into Its Pathobiology and Molecular Mechanisms , 2021, Journal of clinical medicine.

[4]  H. Wilke,et al.  Influences of functional structures on the kinematic behavior of the cervical spine. , 2020, The spine journal : official journal of the North American Spine Society.

[5]  Maria Luisa Ruspi,et al.  The strain distribution in the lumbar anterior longitudinal ligament is affected by the loading condition and bony features: An in vitro full-field analysis , 2020, PloS one.

[6]  C. Pezowicz,et al.  The denticulate ligament - Tensile characterisation and finite element micro-scale model of the structure stabilising spinal cord. , 2019, Journal of the mechanical behavior of biomedical materials.

[7]  Christopher M De Geer Intervertebral Disk Nutrients and Transport Mechanisms in Relation to Disk Degeneration: A Narrative Literature Review , 2018, Journal of chiropractic medicine.

[8]  Zengxin Gao,et al.  Percutaneous Endoscopic Lumbar Spine Surgery for Lumbar Disc Herniation and Lumbar Spine Stenosis: Emphasizing on Clinical Outcomes of Transforaminal Technique , 2018 .

[9]  Khoi D. Than,et al.  Laminoplasty versus laminectomy with posterior spinal fusion for multilevel cervical spondylotic myelopathy: influence of cervical alignment on outcomes. , 2017, Journal of neurosurgery. Spine.

[10]  F. Rannou,et al.  Anatomical specificities of the degenerated cervical spine: a narrative review of clinical implications, with special focus on targeted spinal injections. , 2016, Annals of physical and rehabilitation medicine.

[11]  L. Setton,et al.  Identifying molecular phenotype of nucleus pulposus cells in human intervertebral disc with aging and degeneration , 2016, Journal of orthopaedic research : official publication of the Orthopaedic Research Society.

[12]  S. Jung,et al.  Ischemic Cervical Myelopathy Caused by Vertebral Artery Dissection: The Clinical Utility of a Motor-evoked Potential Study , 2016, The neurologist.

[13]  Jeffrey C. Wang,et al.  The Evaluation and Observation of “Hidden” Hypertrophy of Cervical Ligamentum Flavum, Cervical Canal, and Related Factors Using Kinetic Magnetic Resonance Imaging , 2015, Global spine journal.

[14]  M. Aebi,et al.  Junctional spinal disorders in operated adult spinal deformities: present understanding and future perspectives , 2013, European Spine Journal.

[15]  H. Yoshikawa,et al.  Three-dimensional motion of the uncovertebral joint during head rotation. , 2012, Journal of neurosurgery. Spine.

[16]  A. Staines,et al.  Mechanisms-based classifications of musculoskeletal pain: part 2 of 3: symptoms and signs of peripheral neuropathic pain in patients with low back (± leg) pain. , 2012, Manual therapy.

[17]  L. Ferrara The Biomechanics of Cervical Spondylosis , 2012, Advances in orthopedics.

[18]  K. Riew,et al.  Comparison of anterior cervical fusion after two-level discectomy or single-level corpectomy: sagittal alignment, cervical lordosis, graft collapse, and adjacent-level ossification. , 2009, The spine journal : official journal of the North American Spine Society.

[19]  Guizhong Wu,et al.  The relationship between the cervical spinal canal diameter and the pathological changes in the cervical spine , 2009, European Spine Journal.

[20]  M. Fujii,et al.  Dynamic Evaluation of the Spinal Cord in Patients With Cervical Spondylotic Myelopathy Using a Kinematic Magnetic Resonance Imaging Technique , 2009, Journal of spinal disorders & techniques.

[21]  S. Yabuki,et al.  A Segmental Partial Laminectomy for Cervical Spondylotic Myelopathy: Anatomical Basis and Clinical Outcome in Comparison With Expansive Open-Door Laminoplasty , 2009, Spine.

[22]  H. Baba,et al.  Radiographic Predictors for the Development of Myelopathy in Patients With Ossification of the Posterior Longitudinal Ligament: A Multicenter Cohort Study , 2008, Spine.

[23]  Michael J Lee,et al.  Prevalence of cervical spine stenosis. Anatomic study in cadavers. , 2007, The Journal of bone and joint surgery. American volume.

[24]  E. Benzel,et al.  CERVICAL SPONDYLOSIS ANATOMY: PATHOPHYSIOLOGY AND BIOMECHANICS , 2007, Neurosurgery.

[25]  M. Hadley,et al.  ANTERIOR CERVICAL APPROACH FOR THE TREATMENT OF CERVICAL MYELOPATHY , 2007, Neurosurgery.

[26]  Michael G Fehlings,et al.  Pathophysiology of cervical myelopathy. , 2006, The spine journal : official journal of the North American Spine Society.

[27]  P. K. Kim,et al.  Indications for circumferential surgery for cervical spondylotic myelopathy. , 2006, The spine journal : official journal of the North American Spine Society.

[28]  M. Pope,et al.  The Length of the Cervical Cord: Effects of Postural Changes in Healthy Volunteers Using Positional Magnetic Resonance Imaging , 2006, Spine.

[29]  Edward C Benzel,et al.  Stretch-associated Injury in Cervical Spondylotic Myelopathy: New Concept and Review , 2005, Neurosurgery.

[30]  Lutz Claes,et al.  A three-dimensional collagen matrix as a suitable culture system for the comparison of cyclic strain and hydrostatic pressure effects on intervertebral disc cells. , 2005, Journal of neurosurgery. Spine.

[31]  N. Muthukumar Ossification of the Ligamentum Flavum as a Result of Fluorosis Causing Myelopathy: Report of Two Cases , 2005, Neurosurgery.

[32]  Keita Ito,et al.  Correlation of radiographic and MRI parameters to morphological and biochemical assessment of intervertebral disc degeneration , 2005, European Spine Journal.

[33]  D. Walsh Angiogenesis in osteoarthritis and spondylosis: successful repair with undesirable outcomes , 2004, Current opinion in rheumatology.

[34]  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.

[35]  P. Pavlov Anterior decompression for cervical spondylotic myelopathy , 2003, European Spine Journal.

[36]  P. Cooper,et al.  Laminectomy and Posterior Cervical Plating for Multilevel Cervical Spondylotic Myelopathy and Ossification of the Posterior Longitudinal Ligament: Effects on Cervical Alignment, Spinal Cord Compression, and Neurological Outcome , 2003 .

[37]  C. Niu,et al.  Cervical degenerative disease at flexion-extension MR imaging: prediction criteria. , 2003, Radiology.

[38]  A. Freemont,et al.  Nerve growth factor expression and innervation of the painful intervertebral disc , 2002, The Journal of pathology.

[39]  Meic H. Schmidt,et al.  Cervical myelopathy associated with degenerative spine disease and ossification of the posterior longitudinal ligament. , 2002, Seminars in neurology.

[40]  H. Horner,et al.  2001 Volvo Award Winner in Basic Science Studies: Effect of Nutrient Supply on the Viability of Cells From the Nucleus Pulposus of the Intervertebral Disc , 2001, Spine.

[41]  D. Gore Roentgenographic Findings in the Cervical Spine in Asymptomatic Persons: A Ten-Year Follow-up , 2001, Spine.

[42]  R. Maciewicz,et al.  Distribution of aggrecanase (ADAMts 4/5) cleavage products in normal and osteoarthritic human articular cartilage: the influence of age, topography and zone of tissue. , 2001, Osteoarthritis and cartilage.

[43]  N Yoganandan,et al.  Geometric and mechanical properties of human cervical spine ligaments. , 2000, Journal of biomechanical engineering.

[44]  B. Caterson,et al.  Matrix Metalloproteinases And Aggrecanase: Their Role in Disorders of the Human Intervertebral Disc , 2000, Spine.

[45]  R. Herz,et al.  Soft cervical disc herniation. Influence of cervical spinal canal measurements on development of neurologic symptoms. , 1999, Spine.

[46]  H. Mehdorn,et al.  Kinematic MR Imaging in Surgical Management of Cervical Disc Disease, Spondylosis and Spondylotic Myelopathy , 1999, Acta radiologica.

[47]  L. Claes,et al.  Intradiscal pressure recordings in the cervical spine. , 1999, Neurosurgery.

[48]  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.

[49]  T. Albert,et al.  Postlaminectomy Kyphosis , 1998, Spine.

[50]  S. Roberts,et al.  Changes in Collagen Cross‐Linking in Degenerative Disc Disease and Scoliosis , 1998, Spine.

[51]  A Prescher,et al.  Anatomy and pathology of the aging spine. , 1998, European journal of radiology.

[52]  J. Hipp,et al.  A Motion Analysis of the Cervical Facet Joint , 1998, Spine.

[53]  K. Ito,et al.  [Cervical spinal cord infarction in a patient with unilateral internal carotid artery occlusion and cervical spondylosis]. , 1997, Rinsho shinkeigaku = Clinical neurology.

[54]  J. LaManna,et al.  Viscoelastic Relaxation and Regional Blood Flow Response to Spinal Cord Compression and Decompression , 1997, Spine.

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

[56]  Hitoshi Takahashi,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 , 1996 .

[57]  Ronald P. McCabe,et al.  Cervical Stability After Sequential Capsule Resection , 1993, Spine.

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

[59]  J. Ecklund,et al.  Cervical spondylotic myelopathy: treatment with posterior decompression and Luque rectangle bone fusion. , 1991, Neurosurgery.

[60]  H. Pesch,et al.  “Physiological osteoporosis” and “osteoblast insufficiency” in old age , 1990, Archives of Orthopaedic and Trauma Surgery.

[61]  L. Yahia,et al.  Ultrastructure of the Human Interspinous Ligament and Ligamentum Flavum A Preliminary Study , 1990, Spine.

[62]  A. Sances,et al.  Dynamic Response of Human Cervical Spine Ligaments , 1989, Spine.

[63]  Augustus A. White,et al.  Biomechanics of Nonacute Cervical Spinal Cord Trauma , 1988, Spine.

[64]  T. Yasuma,et al.  PATHOLOGICAL CHANGES IN THE CARTILAGINOUS PLATES IN RELATION TO INTERVERTEBRAL DISC LESIONS , 1988, Acta pathologica japonica.

[65]  P. Cooper,et al.  Radical resection of intramedullary spinal cord tumors in adults. Recent experience in 29 patients. , 1985, Journal of neurosurgery.

[66]  K. Hayashi,et al.  Origin of the uncus and of Luschka's joint in the cervical spine. , 1985, The Journal of bone and joint surgery. American volume.

[67]  R. Zimmerman,et al.  Brain stem infarction due to chiropractic manipulation of the cervical spine. , 1983, Southern medical journal.

[68]  H. Larocca,et al.  The Developmental Segmental Sagittal Diameter of the Cervical Spinal Canal in Patients with Cervical Spondylosis , 1983, Spine.

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

[70]  P. Kaplan Cervical spondylitic myelopathy. , 1978, Archives of neurology.

[71]  K. Ono,et al.  Cervical Myelopathy Secondary to Multiple Spondylotic Protrusions: A Clinicopathologic Study , 1977 .

[72]  L. Pitts,et al.  The Role of Ischemia in the Pathogenesis of Cervical Spondylotic Myelopathy: A Review and New Microangiographic Evidence , 1977 .

[73]  C. Wilson,et al.  Experimental cervical myelopathy: autoradiographic studies of spinal cord blood flow patterns. , 1976, Surgical neurology.

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

[75]  C. Wilson,et al.  Experimental cervical myelopathy: effects of compression and ischemia on the canine cervical cord. , 1972, Journal of neurosurgery.

[76]  C. Wilson,et al.  Experimental cervical myelopathy. II. Acute ischemic myelopathy. , 1969, Archives of neurology.

[77]  J. Bland,et al.  Luschka's Joint. , 1965 .

[78]  Operative Surgery , 1950 .

[79]  Clinical Biomechanics Of The Spine 2nd Edition , 2021 .

[80]  Y. Ohara Ossification of the Ligaments in the Cervical Spine, Including Ossification of the Anterior Longitudinal Ligament, Ossification of the Posterior Longitudinal Ligament, and Ossification of the Ligamentum Flavum. , 2018, Neurosurgery clinics of North America.

[81]  J. Piquer,et al.  The degenerative cervical spine. , 2016, Radiologia.

[82]  Patricia Dolan,et al.  Spine biomechanics. , 2005, Journal of biomechanics.

[83]  S. Iijima,et al.  Pathology of spinal cord lesions caused by ossification of the posterior longitudinal ligament , 2004, Acta Neuropathologica.

[84]  Raj Rao Neck pain, cervical radiculopathy, and cervical myelopathy: pathophysiology, natural history, and clinical evaluation. , 2003, Instructional course lectures.

[85]  R. P. Oliveira,et al.  Aging of the elastic and collagen fibers in the human cervical interspinous ligaments. , 2002, The spine journal : official journal of the North American Spine Society.

[86]  N Yoganandan,et al.  Biomechanics of the cervical spine Part 2. Cervical spine soft tissue responses and biomechanical modeling. , 2001, Clinical biomechanics.

[87]  M. Modrzejewski,et al.  A possible correlation between vertebral artery insufficiency and degenerative changes in the cervical spine , 1998, European Archives of Oto-Rhino-Laryngology.

[88]  J. Polak,et al.  Sensory and sympathetic innervation of the vertebral endplate in patients with degenerative disc disease. , 1997, The Journal of bone and joint surgery. British volume.

[89]  H. Bohlman Cervical spondylosis and myelopathy. , 1995, Instructional course lectures.

[90]  N Yoganandan,et al.  Biomechanics of cervical spine trauma. , 1991, Clinical neurosurgery.

[91]  A. Mark,et al.  Abnormal magnetic-resonance scans of the cervical spine in asymptomatic subjects. A prospective investigation. , 1990, The Journal of bone and joint surgery. American volume.

[92]  B. Griefahn,et al.  [Calcinosis of intervertebral disks--relatively rare, heterogenous and mostly benign]. , 1987, Zeitschrift fur arztliche Fortbildung.

[93]  M. Hamada,et al.  Etiologic factors of myelopathy. A radiographic evaluation of the aging changes in the cervical spine. , 1987, Clinical orthopaedics and related research.

[94]  H. B. Griffith Ligamentum flavum. , 1985, Surgical neurology.

[95]  V. Goel,et al.  An in-vitro study of the kinematics of the normal, injured and stabilized cervical spine. , 1984, Journal of biomechanics.