Cervical spondylitic myelopathy
- Incidence: 20.00 cases per 100,000 person-years
- Peak incidence: 70+ years
- Sex ratio: 1:1
|Cervical spondylitic myelopathy||1|
- a variety of motor weakness, sensory loss and bladder/bowel dysfunction may be seen
- neck pain
- wide-based, ataxic or spastic gait
- upper motor neuron weakness in the lower legs - increased reflexes, increased tone and upgoing plantars
- bladder dysfunction e.g. urgency, retention
Currently, decompressive surgery is the only effective treatment. It has been shown to prevent disease progression. Close observation is an option for mild stable disease, but anything progressive or more severe requires surgery to prevent further deterioration. Physiotherapy should only be initiated by specialist services, as manipulation can cause more spinal cord damage.
Postoperatively, patients with cervical myelopathy require ongoing follow-up as pathology can 'recur' at adjacent spinal levels, which were not treated by the initial decompressive surgery. This is called adjacent segment disease. Furthermore, surgery can change spinal dynamics increasing the likelihood of other levels being affected. Patients sometimes develop mal-alignment of the spine, including kyphosis and spondylolisthesis, and this can also affect the spinal cord. All patients with recurrent symptoms should be evaluated urgently by specialist spinal services.