Current Concepts and Management Strategies in Cervical Spondylotic Myelopathy

Abstract

Abstract Early diagnosis and treatment of cervical spondylotic myelopathy (CSM) are critical to achieve satisfactory results and successful functional outcomes for the patients. Usually, such patients present late, resulting in unsatisfactory treatment outcomes. It is not uncommon to see clinicians failing to recognize the early symptoms there by resulting in delayed referrals to spine surgeons. The objective of this review is to highlight the salient clinical features, pathogenesis, and management options for CSM. The epidemiology, applied anatomy, and pathogenesis of CSM are discussed, along with a review of current literature regarding the management of CSM. A thorough evaluation needs to be done to rule out medical causes for myelopathy and other neurological conditions which mimic CSM. Those with mild CSM with minimal symptoms need to be observed carefully at regular intervals. Early intervention in patients with moderate-to-severe CSM is superior to conservative treatment. Surgical strategies include anterior, posterior, or combined approaches. A thorough decompression of the spinal cord and roots and restoration of cervical lordosis should be the primary goal of the operating surgeon. Needless to mention high quality postoperative rehabilitation and exercise programs go a long way in achieving satisfactory results after surgery.