Cervical Myelopathy: Diagnosis and Surgical Strategies

Abstract

Cervical myelopathy, a condition caused by compression of the spinal cord in the neck, is characterized by an insidious onset with slow clinical deterioration; however, it can have a rapid progression in a subset of patients, culminating in spinal cord damage/injury. In elderly patients, Cervical myelopathy is marked by multifaceted deterioration of the anatomic structures in the spinal column. Injuries can result in more acute presentations of Cervical myelopathy. Symptoms typically stem from mechanical pressure and ischemic changes exerted on the spinal cord. Common symptoms include neck pain/stiffness, spasticity/balance and gait dysfunction, loss of dexterity and fine motor movements, and upper and lower extremity dysesthesias. To diagnose accurately, a detailed history and physical examination are required. Radiographs, computed tomography (CT), and magnetic resonance imaging (MRI) are often needed, with MRI being the gold standard. Many surgical approaches exist to address spinal cord compression. The surgical approach is influenced by several factors: the exact location of cord compression (anterior/posterior), the number of levels of stenosis, overall spinal alignment, body habitus and other factors such as prior surgery.