Cervical Spondylotic Myelopathy

Cervical spondylotic myelopathy is characterized by compression of the spinal cord in the cervical spine (neck). This condition is potentially serious, as spinal cord compression can lead to paralysis.

Causes of Cervical Spondylotic Myelopathy

The most common cause of cervical spondylotic myelopathy is the natural degenerative spinal change that happens with age. Spinal discs act as shock absorbers between the bones in the neck. As these discs degenerate and lose water content, the following may occur:

• Disc space loses height, causing increased pressure and stress on the spinal facet joints. This increased pressure causes the joints to degenerate and the bone to develop osteoarthritis.
• Herniated or bulging cervical discs may apply pressure to the spinal cord.

Other possible causes include neck injuries, infection of tumors or rheumatoid arthritis.

Symptoms of Cervical Spondylotic Myelopathy

Common symptoms of cervical spondylotic myelopathy include:

• Difficulty walking (loss of balance)
• Neck/back pain and stiffness
• Problems with coordination or feeling clumsy
• Tingling and numbness
• Weakness, including difficulty lifting and dropping things.

Treatment for Cervical Spondylotic Myelopathy

Many medical sources suggest surgery as the only effective treatment for cervical spondylotic myelopathy. However, some people alleviate mild symptoms of neck pain with:

• Exercise, which improves neck strength and flexibility
• Non-steroidal anti-inflammatory medications (NSAIDs), which reduce swelling and pain
• Soft cervical collars, which limit neck motion and rest the neck muscles.

The American Academy of Orthopaedic Surgeons states that chiropractic care should never be used to treat spinal cord compression. However, a 2006 study conducted by the Rhode Island Spine Center suggests that cervical spinal cord compression found on an MRI might not necessarily exclude chiropractic care, which may alleviate mild spondylotic myelopathy symptoms. However, even with these recent findings, many choose to err on the side of caution and not opt for this type of treatment.

Cervical Spondylotic Myelopathy: Surgery

The goal of cervical spondylotic myelopathy surgery is to widen the space for the spinal cord and decompress the spinal canal, causing less neck and back pain. You'll want to discuss each surgical option with your doctor, since each has its advantages and disadvantages:

Two anterior approaches (neck surgery from the front) include discectomy and the corpectomy. After either of these procedures, the bones are fused back together with a bone graft:

• Corpectomy: This procedure removes the bones that are pressing on the spinal cord
• Discectomy: This procedure removes the discs that are pressing on the spinal cord.

Two posterior approaches (neck surgery from the back) include the laminectomy and the laminoplasty:

• Laminectomy: This procedure removes the bony arch (lamina), bone spurs and ligaments that are compressing the spinal cord.
• Laminoplasty: This alternative surgery opens up the lamina, without completely removing the bone. (This procedure is often coupled with a spinal fusion.)

Cervical Spondylotic Myelopathy Prevention

Because cervical spondylotic myelopathy is usually associated with aging, the best prevention methods involve making healthy lifestyle choices. In order to decrease your risk of cervical degeneration, you'll want to avoid:

• Holding your head in the same position for long periods (reading, driving, working at a computer)
• Injuries or trauma (car accidents, sports injuries, work injury)
• Jobs requiring extensive neck motion and overhead work
• Mental health issues (depression and anxiety)
• Smoking.

Resources

American Academy of Orthopaedic Surgeons (AAOS) Staff. (2009). Cervical spondylotic myelopathy (spinal cord compression). Retrieved March 29, 2010, from http://orthoinfo.aaos.org/topic.cfm?topic=A00541

Mroz, T. and Schlenk, R.P. (2010). Cervical spondylotic myelopathy requires prompt surgery. Retrieved March 29, 2010, from http://www.spineuniverse.com/professional/pathology/degenerative/cervical-spondylotic-myelopathy-requires-prompt

Murphy, D.R., Hurwitz, E.L. and Gregory, A.A. (2006). Manipulation in the presence of cervical spinal cord compression: A case series. Retrieved March 29, 2010, from http://www.chiro.org/LINKS/ABSTRACTS/ Manipulation_in_the_Presence_of_Cervical_Spinal_Cord_Compression.shtml

Young, W.F. (2000). Cervical spondylotic myelopathy: A common cause of spinal cord dysfunction in older persons. Retrieved March 29, 2010, from http://www.neuroanatomy.wisc.edu/selflearn/CSM.htm