From the Guidelines
Cervical myelopathy in an adult male from India should be evaluated with MRI imaging to assess spinal cord compression, as recommended by the 2021 update of the ACR Appropriateness Criteria for myelopathy 1. The diagnosis and management of cervical myelopathy require a comprehensive approach, considering the patient's symptoms, medical history, and imaging findings. Key aspects of the evaluation include:
- MRI imaging to assess spinal cord compression and identify potential causes such as spondylotic myelopathy, demyelinating diseases, or spinal cord ischemia 1
- Intramedullary cord signal changes on MRI can represent prognostic factors for neurosurgical outcome 1
- Diffusion-weighted imaging can show signal alteration in the spinal cord earlier after symptom onset, which is useful in cases of suspected spinal cord ischemia 1 Treatment options depend on the severity of the condition, ranging from conservative management with neck collar immobilization, physical therapy, and medications like NSAIDs for mild cases, to surgical decompression for moderate to severe cases, such as anterior cervical discectomy and fusion (ACDF) or laminoplasty. In the Indian context, it is essential to consider local factors like availability of specialized care, potential need for referral to tertiary care centers, and post-surgical rehabilitation, which typically lasts 3-6 months. Without timely intervention, cervical myelopathy can lead to progressive neurological deterioration, resulting in permanent disability, emphasizing the importance of prompt medical attention and appropriate management.
From the Research
Cervical Myelopathy in Adult Males from India
- Cervical myelopathy is a neurologic condition that develops insidiously over time as degenerative changes of the spine result in compression of the cord and nearby structures 2.
- It is the most common form of spinal cord injury in adults, yet its diagnosis is often delayed 2.
- The hallmark symptoms of cervical myelopathy include decreased hand dexterity and gait instability as well as sensory and motor dysfunction 2.
Diagnosis and Management
- Magnetic resonance imaging (MRI) is the imaging modality of choice in patients with suspected cervical myelopathy, but computed tomography myelography may be used in patients with contraindications 2.
- Patients with mild cervical myelopathy may be treated surgically or nonoperatively, whereas those with moderate-severe disease are treated operatively 2.
- Surgical decompression is considered the gold standard of treatment, and posterior decompression is an important approach for spine surgeons to have in their toolkits when treating cervical myelopathy 3.
Treatment Options
- Anterior, posterior or combined cervical approaches are used to decompress the spinal cord, with adjunctive fusion being commonly performed 4.
- The choice of one approach over the other depends on patient characteristics, such as number of involved levels, site of compression, cervical alignment, previous surgeries, bone quality, presence of instability, among others, as well as surgeon preference and experience 4.
- Laminectomy and decompression surgery are also treatment options for cervical myelopathy 5.
Outcome Measurements
- Many validated outcomes measures for cervical spondylotic myelopathy already exist, ranging from the disease-specific Nurick grading scale to the generalized Short Form 36-item (SF-36) questionnaire 6.
- Future research must consistently use a broad array of outcome assessments to elucidate the correct utilization of surgical decompression for this disease entity 6.