What is Cervical Myelopathy
Cervical myelopathy is a neurologic condition caused by chronic compression of the spinal cord in the neck due to degenerative changes of the cervical spine, representing the most common form of spinal cord injury in adults. 1, 2
Pathophysiology
Cervical myelopathy develops when age-related degenerative changes narrow the spinal canal through multiple mechanisms 2:
- Static factors include hypertrophy and calcification of ligaments, intervertebral disc degeneration, and osseous tissue changes that progressively narrow the spinal canal 2
- Dynamic factors involve repetitive mechanical trauma to the cord during neck movement 1
- Prolonged severe stenosis leads to demyelination of white matter and can progress to necrosis of both gray and white matter, resulting in potentially irreversible neurological deficits 3
Clinical Presentation
The hallmark symptoms of cervical myelopathy include 1, 4:
- Decreased hand dexterity and difficulty with fine motor tasks (buttoning shirts, handling coins) 1
- Gait instability with wide-based, unsteady walking pattern 1
- Upper extremity symptoms: numbness, tingling, pain radiating down the arms, and weakness in specific muscle groups 5
- Lower extremity symptoms: generalized weakness, stiffness, and spasticity in the legs 5
- Autonomic dysfunction: bowel and bladder incontinence in advanced cases 4, 6
Important caveat: Cervical myelopathy can present atypically with only lower extremity symptoms and no upper extremity findings, which may delay diagnosis 6
Natural History
The clinical course of cervical spondylotic myelopathy is variable 3:
- Many patients experience slow, stepwise decline with periods of stability or quiescence lasting months to years 3, 5
- Approximately 70% of patients with mild CSM maintain stable clinical status over 3 years with nonoperative treatment 5
- Severe or longstanding symptoms have low likelihood of improvement without surgical intervention 3
- **In younger patients (<75 years) with mild disease** (modified Japanese Orthopaedic Association score >12), objectively measurable acute deterioration is rarely seen 3
Diagnostic Approach
MRI is the imaging modality of choice for suspected cervical myelopathy, as it best visualizes soft tissue abnormalities and spinal cord compression 7, 1. CT myelography serves as an alternative for patients with MRI contraindications 1.
Clinical Significance
Prompt recognition and referral are critical because delayed diagnosis leads to long-term disability from irreversible spinal cord damage 1, 4. The condition is increasingly prevalent due to the aging population and represents a major contributor to morbidity worldwide 2.