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Cervical spondylotic myelopathy

Author
Kerry Levin, MD
Section Editor
Michael J Aminoff, MD, DSc
Deputy Editor
Janet L Wilterdink, MD

INTRODUCTION

Cervical spondylosis refers to a progressive degenerative process affecting the cervical vertebral bodies and intervertebral discs. This process can lead to narrowing (stenosis) of the central spinal canal, compressing the cervical spinal cord and producing a syndrome of spinal cord dysfunction known as cervical spondylotic myelopathy. Myelopathy occurs in 5 to 10 percent of patients with symptomatic cervical spondylosis. Other clinical syndromes associated with cervical spondylosis include neck pain and cervical radiculopathy.

Cervical spondylotic myelopathy is the most common cause of myelopathy in adults over 55 years, causing progressive disability and impairing the quality of life [1-4].

Issues related to cervical spondylotic myelopathy will be reviewed here. Neck pain, cervical radiculopathy, spinal cord syndromes, and other spinal cord disorders are discussed separately. (See "Evaluation of the patient with neck pain and cervical spine disorders" and "Clinical features and diagnosis of cervical radiculopathy" and "Anatomy and localization of spinal cord disorders" and "Disorders affecting the spinal cord".)

PATHOPHYSIOLOGY

Cervical spondylosis is a general term for nonspecific, degenerative changes of the cervical spine that are common in older adults. These changes include degeneration of the intervertebral discs resulting in disc herniation; facet, uncovertebral, and vertebral body osteophyte formation; and ossification and hypertrophy of the posterior longitudinal ligament and ligamenta flava. The pathogenesis of cervical spondylosis is discussed separately. (See "Clinical features and diagnosis of cervical radiculopathy", section on 'Cervical spondylosis'.)

These processes can lead to narrowing of the central cervical canal. This in turn can produce dysfunction of the adjacent spinal cord, as the combined result of mechanical compression of neural elements and spinal cord ischemia due to compression of the arterial and/or venous blood supply to the cord [2]. Flexion and extension of the neck may exacerbate compression; the canal diameter is reduced by 2 to 3 mm in flexion, while extension can cause inward buckling of the ligamentum flavum.

                

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Literature review current through: Nov 2016. | This topic last updated: Mon Dec 02 00:00:00 GMT 2013.
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