What is the treatment for cervical spondylitic myelopathy?

From the Guidelines

The treatment for cervical spondylitic myelopathy typically involves both non-surgical and surgical approaches, with surgical intervention often necessary for moderate to severe cases with progressive neurological deficits. For mild cases, conservative management includes physical therapy focusing on neck strengthening exercises, pain management with NSAIDs like ibuprofen (400-800mg three times daily) or naproxen (500mg twice daily), and sometimes muscle relaxants such as cyclobenzaprine (5-10mg three times daily) for associated muscle spasms 1. A soft cervical collar may provide temporary relief but isn't recommended long-term as it can lead to muscle weakness.

Key Considerations

• The main surgical options include anterior cervical discectomy and fusion (ACDF), anterior cervical corpectomy and fusion, or posterior approaches like laminectomy with or without fusion 1.
• Surgery aims to decompress the spinal cord and stabilize the spine to prevent further neurological deterioration.
• The choice of surgical approach depends on the specific pathology, number of levels involved, and the patient's overall health status.
• Early intervention is crucial as the condition can cause permanent spinal cord damage if left untreated, and neurological recovery after surgery is often incomplete if significant deficits have already developed.

Important Factors

• Extrinsic compression of the spinal cord is a common cause of myelopathy, and evaluation for this condition is essential in all patients with acute or chronic myelopathy 1.
• Other causes of myelopathy, such as demyelinating diseases, metabolic derangements, and neoplastic causes, should also be considered and excluded 1.
• The patient's overall health status and the presence of any comorbidities should be taken into account when deciding on the best course of treatment.

Treatment Goals

• The primary goal of treatment is to prevent further neurological deterioration and improve or stabilize neurological function.
• Secondary goals include managing pain and improving quality of life.
• A multidisciplinary approach, including physical therapy, pain management, and surgical intervention, may be necessary to achieve these goals.

From the Research

Treatment Options for Cervical Spondylitic Myelopathy

• The treatment for cervical spondylitic myelopathy (CSM) depends on the severity of the disease, with patients having mild CSM potentially being treated surgically or nonoperatively, while those with moderate to severe disease are typically treated operatively 2, 3, 4, 5.
• Surgical decompression is intended to arrest neurologic progression and can improve function in many patients, with the ideal surgical approach determined by factors such as the location and characteristics of spinal cord compression, as well as the patient's cervical sagittal alignment 3, 4, 5.
• Conservative options, such as careful observation, may be employed for patients with mild CSM, but the effectiveness of these treatments is unproven 3, 4.
• The goal of surgery is to decompress the cord, expand the spinal canal, restore cervical lordosis, and stabilize the spine when necessary, with the optimal surgical approach still being debated 4, 5.

Surgical Approaches

• Surgical treatment can be performed via an anterior, posterior, or combined approach, with each technique having distinct complications that can be mitigated by appropriate patient selection 5.
• The choice of surgical approach depends on factors such as the number of levels involved, the location of the pathology, and the patient's baseline cervical sagittal alignment 4, 5.

Importance of Early Diagnosis and Treatment

• Early recognition and treatment of CSM are essential for optimal outcomes, as delayed diagnosis and management can result in long-term disability 2, 4.
• Prompt referral to a spine surgeon is recommended for any patient suspected of having CSM, especially those with progressive and moderate to severe neurologic deficits 2, 3.