Degenerative cervical myelopathy

Abstract

Cervical myelopathy is the most common cause of acquired spinal cord compromise. The concept of degenerative cervical myelopathy (DCM), defined as symptomatic myelopathy associated with degenerative arthropathic changes in the spine axis, is being introduced. Given its progressive nature, treatment options have to be chosen in a timely manner. Surgical options include anterior discectomy and fusion (ACDF), anterior corpectomy and fusion (ACCF), arthroplasty (in highly select cases), posterior laminectomy with/without fusion, and laminoplasty. Indications for each should be carefully considered in individual patients. Riluzole, a sodium-glutamate antagonist, is a promising option to optimize neurologic outcomes post-surgery and is being examined in the CSM-Protect Randomized Controlled Trial. Preoperative risk assessment is mandatory for prognostication. Sagittal alignment is known to play an important role to optimize surgical outcome. Guidelines for optimal management of DCM are in process. In principle, all but the mildest cases of DCM should be offered surgery for optimal outcome.

Keywords: Adjuvant therapy; Approach; Degenerative cervical myelopathy; Non-surgical treatment; Prognosis; Surgical treatment.

Fig. 1

An artistic depiction of the pathobiology of degenerative cervical myelopathy [•]. Medical illustration by Diana Kryski (Kryski Biomedia), reused with permission. PLL indicates posterior longitudinal ligament, CSF cerebrospinal fluid

Fig. 2

An illustrative case of anterior surgery. Multiple level spinal cord compression by degenerative discs with mild kyphosis was treated by 4-level anterior cervical discectomy and fusion (C3-7). Optimal decompression was achieved in each level and the post-operative alignment was lordotic by the reconstruction. a Preoperative T2 weighted MRI sagittal image, b post-operative T2 weighted MRI sagittal image, c post-operative antero-posterior radiograph, d post-operative lateral radiograph

Fig. 3

An illustrative case of posterior surgery. Multiple level spinal cord compression by degenerative discs and ligamentum flavum hypertrophy was treated by posterior laminectomy and fusion (C2-T1). Solid fixation were achieved at both ends of the construct by C2 pars screws and T1 pedicle screws. a Preoperative T2 weighted MRI sagittal image, b post-operative T2 weighted MRI sagittal image, c post-operative antero-posterior radiograph, d post-operative lateral radiograph