Cervical spondylotic myelopathy: pathophysiology, diagnosis, and surgical techniques

Abstract

Cervical spondylotic myelopathy is a degenerative spinal disease which may lead to significant clinical morbidity. The onset of symptoms is usually insidious, with long periods of fixed disability and episodic worsening events. Regarding the pathophysiology of CSM, the repeated injuries to the spinal cord are caused by both static and dynamic mechanical factors. The combination of these factors affects the spinal cord basically through both direct trauma and ischemia. Regarding the diagnosis, both static and dynamics X-rays, as well as magnetic resonance imaging are important for preoperative evaluation as well as individualizing surgical planning. The choice of the most appropriate technique is affected by patient's clinical condition radiologic findings, as well as surgeon's experience. In opposition to the old belief that patients presenting mild myelopathy should be treated conservatively, there has progressively been amount of evidence indicating that the clinical course of this disease is progressive deterioration and that early surgical intervention improves long-term functional recovery and neurological prognosis.

Figure 1

Simple radiograph demonstrating C4-C5 subluxation as well as C5-C6 degenerative spondylosis in a patient with symptoms of CSM.

Figure 2

T2-weighted sagittal MRI demonstrating a 2-level CSM with predominantly anterior compression due to soft disc herniation.