From the Guidelines
Cervical spine myelopathy is a neurological condition that requires prompt evaluation and treatment to prevent permanent neurological damage, and the initial imaging modality of choice is MRI of the spine, as recommended by the American College of Radiology (1).
Diagnosis and Treatment
The condition is typically caused by compression of the spinal cord in the neck region, resulting from degenerative changes in the spine, such as age-related disc degeneration, bone spurs, or conditions like ossification of the posterior longitudinal ligament (1).
- The diagnosis of cervical spine myelopathy involves a combination of physical examination, patient history, and imaging studies, with MRI being the most useful modality for evaluating the spinal cord and surrounding structures (1).
- Treatment depends on the severity of the condition, with surgical decompression being the preferred option for moderate to severe cases, and conservative management, including physical therapy and pain management, being attempted first for mild cases (1).
Importance of Early Intervention
- Early intervention is crucial in preventing permanent neurological damage, including weakness, numbness, balance problems, and bowel/bladder dysfunction (1).
- The condition can progress rapidly, and delayed treatment can result in irreversible damage to the spinal cord (1).
Surgical Options
- Surgical options for cervical spine myelopathy include anterior cervical discectomy and fusion (ACDF), laminoplasty, or laminectomy with fusion (1).
- The choice of surgical procedure depends on the individual patient's condition and the severity of the compression (1).
Conservative Management
- Conservative management may be attempted first for mild cases, including physical therapy focusing on gentle neck exercises, pain management with NSAIDs like ibuprofen (400-800mg three times daily) or naproxen (500mg twice daily), and activity modification to avoid neck hyperextension (1).
- Patients should be monitored closely, as the condition can progress, and surgical intervention may be necessary if conservative management fails (1).
From the Research
Cervical Spine Myelopathy
- Cervical spondylotic myelopathy (CSM) is a major cause of disability, particularly in elderly patients, and is caused by narrowing of the cervical spinal canal 2, 3.
- The clinical presentation and natural history of CSM can vary, alternating between quiescent and insidious to stepwise decline or rapid neurological deterioration 3.
- For mild CSM, conservative options such as physical therapy treatment with emphasis on manual therapy and therapeutic exercise may be employed with careful observation, and have been shown to achieve satisfactory results in some cases 2.
- However, surgical intervention has been shown to be superior for moderate to severe CSM, with the goal of surgery being to decompress the cord with expansion of the spinal canal, while restoring cervical lordosis, and stabilizing when the risk of cervical kyphosis is high 3, 4.
Diagnosis and Treatment
- MRI plays an important role in the diagnosis and evaluation of CSM, and dynamic MRI may be a useful tool in the treatment of CSM, especially in surgical decision making 5.
- The use of dynamic MRI can help to demonstrate the correlation between disc, spinal cord, posterior structures, and abnormal signal in spinal cord, and can provide valuable information for surgical planning 5.
- A clinical practice guideline for the management of patients with degenerative cervical myelopathy recommends surgical intervention for patients with moderate and severe DCM, and suggests offering surgical intervention or a supervised trial of structured rehabilitation for patients with mild DCM 4.
Non-Surgical Management
- Nonoperative management may have a role in the treatment of mild myelopathy, but is not recommended for moderate and severe myelopathy, as it results in outcomes inferior to those of surgery 6.
- Clinical and/or electrophysiological evidence of cervical radiculopathy has been shown to predict progression of myelopathy, and should prompt strong consideration of surgical decompression 6.
- The indications for nonoperative management are ostensibly limited due to the unpredictably progressive nature of cervical myelopathy 6.