Cervical spondylosis with cervical myelopathy, commonly referred to as cervical spondylotic myelopathy (CSM), refers to impaired function of the spinal cord caused by degenerative changes of the discs and facet joints in the cervical spine (neck). Show
See Spondylosis: What It Actually Means In severe cases, spondylosis can cause myelopathy, which is spinal cord compression that results in neurological deficits. Watch: Cervical Spondylosis with Myelopathy Animation This condition is the most common disorder causing dysfunction of the spinal cord (known as myelopathy) and results from compression of the spinal cord. Most patients with this condition are over 50 years of age, but the age of onset is variable depending on the degree of congenital spinal canal narrowing. The process that leads to spinal cord compression is a result of arthritis in the neck (also called cervical spondylosis or degenerative joint disease), which is incompletely understood and likely has a number of causes. See Cervical Osteoarthritis (Neck Arthritis) Factors That Lead to Cervical Spondylosis with MyelopathyFactors that are thought to contribute to development of cervical spondylosis with myelopathy include:
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In This Article:These changes in the cervical spine produce narrowing of the spinal canal itself, leading to thickening of the posterior longitudinal ligament and bone spur (osteophyte) formation compressing the spinal cord, most commonly at the C4-C7 levels. The end result is chronic compression of the spinal cord and nerve roots leading to impaired blood flow and neurological deficit resulting in frank damage within the spinal cord itself. A related condition that is more commonly being appreciated is ossification of the posterior longitudinal ligament (OPLL) that can also lead to chronic spinal cord compression. Cervical spondylosis is osteoarthritis of the cervical spine causing stenosis of the canal and sometimes cervical myelopathy due to encroachment of bony osteoarthritic growths (osteophytes) on the lower cervical spinal cord, sometimes with involvement of lower cervical nerve roots (radiculomyelopathy). Diagnosis is by MRI or CT.
Treatment may involve nonsteroidal anti-inflammatory drugs and a soft cervical collar or cervical laminectomy. Cord compression commonly causes gradual spastic paresis, paresthesias, or both in the hands and feet and may cause hyperreflexia. Neurologic deficits may be asymmetric,
nonsegmental, and aggravated by cough or Valsalva maneuvers. After trauma, people with cervical spondylosis may develop a central cord syndrome (see table Spinal Cord
Syndromes Spinal Cord Syndromes Eventually, muscle atrophy
and flaccid paresis may develop in the upper extremities at the level of the lesion, with spasticity below the level of the lesion. Nerve root compression commonly causes early radicular pain; later, there may be weakness, hyporeflexia, and muscle atrophy.
Cervical spondylosis is suspected when characteristic neurologic deficits occur in patients who are older, have osteoarthritis, or have radicular pain at the C5 or C6 levels. Diagnosis of cervical spondylosis is by MRI, CT, or CT myelography.
If the cord is severely compressed, cervical laminectomy is usually needed; a posterior approach can relieve the compression but leaves anterior compressive osteophytes and may result in spinal instability and kyphosis. Thus, an anterior approach with spinal fusion is generally preferred. Patients with only radiculopathy may try nonsurgical treatment with NSAIDs and a soft cervical collar; if this approach is ineffective, surgical decompression may be required. Indications for surgical decompression include
Baclofen may help relieve spasticity.
Click here for Patient Education Copyright © 2022 Merck & Co., Inc., Rahway, NJ, USA and its affiliates. All rights reserved. What is spondylosis with myelopathy or radiculopathy?Spondylosis refers to degenerative, or age-related, changes in the spine. These changes include disc degeneration, bone spurs, and thickened ligaments. Cervical spondylotic myelopathy, therefore, is myelopathy (spinal cord damage) caused by spondylosis (degeneration) in the cervical spine (neck).
What is the best treatment for cervical spondylosis?In most cases, the symptoms of cervical spondylosis can be relieved using a combination of: medication – such as non-steroidal anti-inflammatory drugs (NSAIDs), including ibuprofen. exercise – such as swimming and walking. self care techniques – such as supporting your neck with a firm pillow at night.
What does cervical spondylosis with radiculopathy mean?Cervical radiculopathy and cervical myelopathy. Cervical spondylosis is an age-related degeneration ('wear and tear') of the bones (vertebrae) and discs in the neck. It can progress to cause cervical radiculopathy or cervical myelopathy (described below). Most cases do not.
What is cervical spondylosis with myelopathy and radiculopathy?Cervical spondylosis with cervical myelopathy, commonly referred to as cervical spondylotic myelopathy (CSM), refers to impaired function of the spinal cord caused by degenerative changes of the discs and facet joints in the cervical spine (neck).
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