What are the other Names for this Condition? (Also known as/Synonyms)

• Cervical Myelopathy
• CSM (Cervical Spondylotic Myelopathy)
• Spinal Cord Compression

What is Cervical Spondylotic Myelopathy? (Definition/Background Information)

• Myelopathy is a term that describes any neurological defect associated with the spinal cord
• Cervical Spondylotic Myelopathy (CSM) is a common spinal condition associated with men and women over the age of 55 years, which is characterized by compression of the spinal cord, within the neck
• It is caused by degenerative transformation (due to wear and tear, injury, or infection) of intervertebral discs and facet joints of the spine
• Some common signs and symptoms associated with CSM include pain, numbness, and weakness

Who gets Cervical Spondylotic Myelopathy? (Age and Sex Distribution)

• Cervical Spondylotic Myelopathy is most commonly observed in men and women over the age of 55. It may also occur in younger individuals, who experience a serious spinal injury
• Predominantly, this condition is observed more in males, than females

What are the Risk Factors for Cervical Spondylotic Myelopathy? (Predisposing Factors)

Common risk factors associated with Cervical Spondylotic Myelopathy include:

• An advancing age
• Formation of bone spurs (osteophytes)
• Dislocation of the vertebrae (subluxation)
• Congenital cervical spinal stenosis (abnormally narrow spinal canal that is present at birth)

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases ones chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Cervical Spondylotic Myelopathy? (Etiology)

Some of the cause associated with Cervical Spondylotic Myelopathy are:

• Obstruction of normal neural impulse flow through the spinal cord
• Any traumatic injury to the spine, caused by an automobile accident
• An inflammatory or autoimmune disorder, such as rheumatoid arthritis
• An abnormal growth on the spine, such as a tumor
• Degeneration (due to aging) of the cervical disc, which causes the space between the vertebra to narrow
• Prolapse of the cervical disc
• Thickening of ligaments within the spinal canal
• Children born with spinal stenosis; a defect that causes narrowing of the spinal canal (narrowing of the open spaces in the spine)

What are the Signs and Symptoms of Cervical Spondylotic Myelopathy?

Signs and symptoms of Cervical Spondylotic Myelopathy include:

• Tingling, numbness, or burning sensation within the upper extremities (paresthesia)
• Sensory changes observed in the lower extremities
• Difficulty walking
• Functional impairment (clumsiness, sense of fine motor skills and coordination may be impaired)
• Loss of bladder/bowel function
• Symptoms associated with disc herniation and vertebrae abnormality are frequently similar, but may develop at different times

How is Cervical Spondylotic Myelopathy Diagnosed?

Diagnostic methods that a physician may use to help diagnose Cervical Spondylotic Myelopathy include:

• Physical examination: The physician will perform a thorough physician examination to determine if the individual has CMS. In addition to this, a complete medical history of the patient will be evaluated
• X-rays: X-rays are useful in visualizing the alignment of bones within the neck
• Magnetic resonance imaging (MRI) of the spine: An MRI is a more detailed scan that uses radio waves and a magnetic field to generate images of interior bones and soft tissues. An MRI scan can usually help identify, if the spinal cord is compressed
• Myelogram: A myelogram is a specialized diagnostic imaging procedure in which, a special dye is injected into the surrounding areas of the spinal cord. X-rays or CT scan images are then taken to help a physician detect any spinal abnormalities
• Electromyography (EMG): An EMG shows the electrical activity of a muscle during rest and when they contract. Examining the electrical activities may help a physician observe any nerve damage, which along with other diagnostic tests, may provide very useful information about the condition

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Cervical Spondylotic Myelopathy?

Complications of Cervical Spondylotic Myelopathy could include:

• Permanent injury to the spinal roots
• Severe disability
• Severe neurogenic atrophy (wasting away of the muscles due to injury to nerves)
• Loss of bladder/bowel function (incontinence)

How is Cervical Spondylotic Myelopathy Treated?

Nonsurgical treatment measures are:

• Wearing a specialized neck brace or cervical collar can help rest the neck muscles, while decreasing the range of motion. This aids by reducing the irritation caused to the nerves in the neck
• Applying a damp heated towel or an ice pack to the neck, can help reduce pain and swelling
• Non-steroidal anti-inflammatory oral medications may be used to treat Cervical Spondylotic Myelopathy (CSM). These medications can help decrease pain and swelling
• Corticosteroid injections into the epidural space (region near the spine, inside the vertebral column) help provide temporary relief of symptoms, and in improving the range of motion. It is important to note that corticosteroid injections only give temporary relief. Prolonged episodes of such injections, may injure the joints in the long-run
• Physical therapy exercises to strengthen and improve flexibility of the neck, which may help reduce the discomfort

Surgical treatment of Spinal Cord Compression may not always help relieve the symptoms. However, a surgical intervention may be recommended, if excessive pain and joint damage are present. Individuals are advised to discuss the alternatives with their physicians, before making a decision.

Surgical procedures to decrease compression of the spinal cord include:

• Anterior cervical discectomy and fusion (ACDF): This surgical procedure is performed through an incision within the front of the neck and involves removing a cervical herniated disc, to relieve pressure on the spinal cord and/or nerves
• Anterior cervical corpectomy and fusion (ACCF): This surgical procedure is also performed through an incision within the front of the neck. Similar to ACDF, in this surgical operation the damaged or diseased vertebral bone and the surrounding cervical discs are removed. A bone graft material is then used to fill the empty space, and it is fused together with the cervical spine
• Cervical laminectomy: This procedure is performed to relieve pressure on the spinal cord and/or the nerves that surround the cervical region (neck) of the body. The lamina bone of the vertebra forms the bony roof of the spinal canal, in the cervical region. During a cervical laminectomy, an incision is made in the lower back and the tissue causing pressure on the nerves removed. This helps creates more space within the spinal canal
• Cervical laminoplasty: Cervical laminoplasty is another procedure performed to relieve pressure on the spinal cord and/or nerves located at the cervical region. During the procedure, an incision is made in the middle part of the neck and tissue, which is causing pressure on the nerves,and is manipulated to widen the spinal canal

How can Cervical Spondylotic Myelopathy be Prevented?

It is extremely difficult to prevent Cervical Spondylotic Myelopathy. However, the following guidelines may be helpful to avoid CSM:

• If you have been previously diagnosed with a vertebral abnormality or disc compression, then avoid participating in any rough/high-impact sports, or undertaking any intensive physical activity
• Limit or avoid activities that may place an abnormal stress on the neck muscles
• Consult an ergonomics specialist to help learn proper lifting techniques, improve your posture, or how to work sitting behind a desk (or on the computer), so as to avoid any unwanted stress to the spine

What is the Prognosis of Cervical Spondylotic Myelopathy? (Outcomes/Resolutions)

• The prognosis of Cervical Spondylotic Myelopathy primarily depends on the severity of the spinal compression. Since, CSM is a slow and progressive condition, severe disability may occur, if the condition is left untreated
• In some individuals, there may be time periods, where progression of the condition is slowed and is more controlled. However, the outcome may differ from one case to the next, depending on the underlying cause
• Surgical treatments for a single disc compression are usually more successful than surgical treatment for several vertebral abnormalities. A high percentage of individuals, who have surgical procedures to relieve pressure, usually notice major improvements in feeling and functioning of their spinal cord

Additional and Relevant Useful Information for Cervical Spondylotic Myelopathy:

Cervical Spondylosis is a degenerative disorder that involves abnormal wear on the vertebrae and soft tissues of the neck (cervical region). It is also known as Arthritis of the Neck. It is different from Cervical Spondylotic Myelopathy.