Diagnosis & Management of Cervical Spondylotic Myelopathy
- RRS Education
Cervical spondylotic myelopathy (CSM) is an insidious, progressive disease resulting from compression of the spinal cord and/or surrounding blood vessels. In North America, CSM accounts for over 50% of non-traumatic spinal cord injury – making it the most common cause. Unfortunately, diagnosis is still often delayed!
Approximately 10% of patients aged 55 and older display clinical signs of CSM, but in the coming decades this number is expected to increase in prevalence as the population of people over the age of 60 increase - these patients will certainly be in chiropractic offices around the globe!
CSM has the potential to cause long-term disability and major neurological impairments. Therefore, identifying patients with CSM in a timely manner is critical for practicing chiropractors (and all primary care clinicians!). This clinical review paper summarized contemporary knowledge on CSM for practicing clinicians…LOG IN OR SUBSCRBE TO ACCESS THIS REVIEW!
THIS WEEK'S RESEARCH REVIEW: “Diagnosis & Management of Cervical Spondylotic Myelopathy”
This paper was published in Journal of the American Board of Family Physicians (2020) and this Review is posted in Recent Reviews, Cervical Spine - Disc & Neurological, Geriatrics and the 2020 Archive.
CSM Pathophysiology"There are a variety of pathologies that can lead to cervical cord compression such as cervical spondylosis and disc herniations. Cervical spondylosis is the progressive, degenerative disease that affects the vertebrae, intervertebral discs, facets, and associated ligaments (most relevant here is the ligamentum flavum). However, the pathophysiology is still not fully understood. Multiple studies have demonstrated a diminished vascular supply through the anterior spinal artery and radicular arteries as they are stretched over a disc or vertebral body (5, 6). This can lead to ischemia of oligodendrocytes, leading to apoptosis and neural demyelination (7). Other factors that are believed to play a role in CSM include: impairment of intracellular energy metabolism, free radical-mediated injury, and cation-mediated cell injury (8). The end result of spinal cord damage in CSM is neuronal dysfunction, which leads to the long-tract signs that are observed clinically (9). Spinal cord compression and subsequent neuronal damage are classified as either static or dynamic mechanical compression (5, 10). Static compression risk factors are constant and result in injury of the cervical canal through stenosis, whereas dynamic factors involve repetitive injury."