From the Guidelines
CSM in medical language stands for Central Spinal Cord Syndrome, a condition characterized by damage to the central part of the spinal cord, often caused by trauma, degenerative changes, or other pathologies. This condition is distinct from other forms of myelopathy, such as those caused by extrinsic compression of the spinal cord, vascular pathologies, or inflammatory conditions 1. The clinical presentation of CSM can vary depending on the level and extent of spinal cord damage, but it often includes symptoms such as weakness, numbness, or tingling in the arms and legs, as well as bladder and bowel dysfunction. Key factors contributing to the development of CSM include spinal degenerative changes, disc herniations, and malalignment, which can be accentuated in the presence of congenitally short pedicles 1. Other causes of extrinsic compression of the spinal cord, such as pathology involving the epidural compartment (abscess or hematoma), primary or metastatic tumors, and postoperative complications, can also lead to CSM 1. Early diagnosis and treatment of CSM are crucial to prevent further damage and improve outcomes, and may involve surgical intervention, physical therapy, and management of underlying conditions. It is essential to evaluate all patients with acute onset myelopathy for extrinsic compression of the spinal cord, as prompt treatment can significantly impact morbidity, mortality, and quality of life 1.
From the Research
Definition of CSM
- Cervical Spondylotic Myelopathy (CSM) is a degenerative disease that represents the most common spinal cord disorder in adults 2.
- CSM develops insidiously as degenerative changes of the cervical spine impact the spinal cord 3.
- It is a neurologic condition that develops insidiously over time as degenerative changes of the spine result in compression of the cord and nearby structures 4.
Symptoms of CSM
- The hallmark symptoms of CSM include decreased hand dexterity and gait instability as well as sensory and motor dysfunction 4.
- Classic symptoms of CSM include poor hand dexterity, new unsteady gait patterns, and new onset and progressive difficulty with motor skills 3.
- Patients often develop debilitating spasticity and weakness 2.
Diagnosis and Management of CSM
- Magnetic resonance imaging is the imaging modality of choice in patients with suspected CSM, but computed tomography myelography may be used in patients with contraindications 3, 4.
- Patients with mild CSM may be treated surgically or nonoperatively, whereas those with moderate-severe disease are treated operatively 4.
- The management of those with CSM has continued to be a controversial topic, with some patients being managed conservatively and others being treated operatively 3.