Treatment considerations of cervical spondylotic myelopathy

Abstract

Cervical spondylotic myelopathy (CSM) is the leading cause of myelopathy in patients over age 50 years. Despite advances, CSM remains a clinical diagnosis and its natural history remains unclear. The treatment of CSM is controversial, especially in patients with mild or moderate clinical disease without rapid progression of symptoms. Herein, we begin with a clinical vignette followed by a brief description of the clinical problems. We discuss evaluation, treatment, and recommendations for the treatment of CSM. Emphasis is drawn to areas of uncertainty and present level of evidence for the treatment modalities of CSM.

MRI of the cervical spine Figure. T2-weighted MRI of the cervical spine in a sagittal view (A) illustrates herniated disks at C3-C4, C4-C5, and C5-C6 as well as an osteophytic spur at C5-C6 with spinal cord compression. T2-weighted imaging in an axial view (B) at C5-C6 shows the level of maximum compression. At the level of maximum compression, C5-C6, a hyperintensity signal (arrow), is illustrated.