From the Guidelines
Multiple falls can contribute to the development of cervical spondylosis and myelopathy, as repeated trauma can damage the vertebrae, discs, and supporting structures in the neck, leading to degenerative changes that can compress the spinal cord. The relationship between falls and these conditions is complex, with falls potentially accelerating the degenerative process of cervical spondylosis, which is primarily caused by age-related wear and tear 1. When someone experiences multiple falls, especially those involving impact to the head or neck, the repeated trauma can lead to disc herniation, bone spurs, and ligament thickening, all of which are characteristic of spondylosis 1. If these degenerative changes compress the spinal cord, cervical myelopathy can develop, causing symptoms like weakness, numbness, coordination problems, and difficulty walking 1. Key factors contributing to spondylotic myelopathy include spinal degenerative changes, disc herniations, and malalignment, which may be accentuated in the presence of congenitally short pedicles 1. Treatment typically involves pain management, physical therapy, and in severe cases, surgical decompression of the spinal cord, with MRI being a useful tool for evaluating the spinal cord and surrounding structures in patients with chronic or progressive myelopathy 1. Anyone experiencing neck pain, weakness, or neurological symptoms after falls should seek medical evaluation promptly to prevent further complications and improve quality of life. Some of the key considerations in the evaluation and management of cervical spondylosis and myelopathy include:
- Evaluation for extrinsic compression of the spinal cord
- Assessment of spinal degenerative changes, disc herniations, and malalignment
- Consideration of congenitally short pedicles
- Use of MRI for evaluating the spinal cord and surrounding structures
- Pain management and physical therapy as initial treatment options
- Surgical decompression of the spinal cord in severe cases.
From the Research
Cervical Spondylosis and Myelopathy
- Cervical spondylotic myelopathy (CSM) is a neurologic condition that develops over time due to degenerative changes in the spine, resulting in compression of the cord and nearby structures 2.
- The condition can be caused by various factors, including static and dynamic factors, and can lead to symptoms such as decreased hand dexterity, gait instability, and sensory and motor dysfunction 2, 3.
Role of Trauma in CSM
- Trauma, including multiple falls, can contribute to the development and progression of CSM, particularly in patients with pre-existing cervical instability 4.
- Even minor trauma to the neck can lead to irreversible spinal cord injury in patients with CSM and cervical instability 4.
- Surgical intervention can help reduce the risk of fall-related neurological deterioration in patients with degenerative cervical myelopathy (DCM) 5.
Diagnosis and Treatment
- Magnetic resonance imaging (MRI) is the imaging modality of choice for diagnosing CSM, but computed tomography (CT) myelography may be used in patients with contraindications 2, 6.
- Treatment for CSM can include surgical or non-operative management, depending on the severity of the condition, with operative treatment being the standard of care for moderate to severe CSM 2, 3.
- Surgical intervention can help improve functional outcomes and reduce the risk of fall-related neurological deterioration in patients with DCM 5.