What is cervical spondylotic myelopathy?

Cervical spondylotic myelopathy refers to a syndrome caused by degenerative changes in the cervical vertebrae and intervertebral discs, leading to stenosis of the central spinal canal, compression of the cervical spinal cord, and resulting in spinal cord dysfunction.

Which department should patients with cervical spondylotic myelopathy visit?

English name: cervical spondylotic myelopathy.

Aliases: myelopathic cervical spondylosis, cervical spinal cord compression, cervical spondylosis with spinal cord compression.

Departments: Spine Surgery, Orthopedics, Neurosurgery, Neurology.

What causes cervical spondylotic myelopathy?

The disease is caused by nonspecific degenerative changes in the cervical spine, including disc degeneration, ossification and hypertrophy of the posterior longitudinal ligament/ligamentum flavum, etc.

These changes can lead to stenosis of the central spinal canal, resulting in compression of the spinal cord's surface blood vessels (causing spinal cord ischemia) or direct compression of the spinal cord. Symptoms are often more noticeable during neck flexion or extension.

Who is commonly affected by cervical spondylotic myelopathy?

The disease is more common in adults, particularly middle-aged and elderly individuals.

What are the symptoms and manifestations of cervical spondylotic myelopathy?

The clinical presentation varies depending on the location and severity of the damage, including:

• Neck and shoulder pain, often radiating to both arms;
• Numbness or abnormal sensations in the arms;
• Weakness or atrophy in the arms or hands;
• Sensory disturbances in the lower limbs, such as a cotton-like sensation under the feet;
• Weakness in the lower limbs; abnormal gait;
• Frequent urination, urgency, or urinary retention;
• Some patients may experience the classic Lhermitte's sign—an electric shock-like sensation in the neck upon flexion, radiating down the spine or to the arms.

Symptoms usually develop insidiously and are difficult to recognize early. Some patients may experience acute worsening after minor neck trauma, leading to severe consequences such as paralysis or bowel/bladder dysfunction.

How is cervical spondylotic myelopathy diagnosed?

Diagnosis is primarily based on medical history, physical examination, and cervical imaging (including MRI or CT scans of the cervical spine).

How is cervical spondylotic myelopathy treated?

Treatment mainly includes nonsurgical and surgical approaches:

• Nonsurgical treatments include soft cervical collars or braces, avoiding high-risk activities that may cause cervical trauma (e.g., falls, heavy lifting, extreme sports), and pain management for severe cases;
• Surgical treatment primarily involves decompression surgery.
• In cases of acute worsening, prompt evaluation by neurosurgery or orthopedics is needed to assess surgical indications, and high-dose corticosteroids may be administered early.

What is the prognosis for cervical spondylotic myelopathy if left untreated?

The prognosis varies among individuals. Some patients may experience gradual progression, leading to gait abnormalities, weakness in the lower limbs or arms, and pain. Others may remain stable for a long time or worsen acutely after minor neck trauma.

How can cervical spondylotic myelopathy be prevented?

Prevention focuses on two aspects:

• First, adopting a lifestyle that avoids accelerating cervical degenerative changes, such as poor neck posture, neck trauma, or frequent heavy lifting, to prevent the onset of the disease;
• Second, preventing acute worsening by using soft cervical collars or braces, avoiding falls, heavy lifting, extreme sports, or other high-risk activities that may cause cervical trauma, and preventing whiplash injuries.