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Cervical Spondylosis and Spondylotic Cervical Myelopathy

By

Michael Rubin

, MDCM, New York Presbyterian Hospital-Cornell Medical Center

Last full review/revision Jan 2020| Content last modified Jan 2020
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NOTE: This is the Professional Version. CONSUMERS: Click here for the Consumer Version

Cervical spondylosis is osteoarthritis of the cervical spine causing stenosis of the canal and sometimes cervical myelopathy due to encroachment of bony osteoarthritic growths (osteophytes) on the lower cervical spinal cord, sometimes with involvement of lower cervical nerve roots (radiculomyelopathy). Diagnosis is by MRI or CT. Treatment may involve nonsteroidal anti-inflammatory drugs and a soft cervical collar or cervical laminectomy.

Cervical spondylosis due to osteoarthritis is common. Occasionally, particularly when the spinal canal is congenitally narrow (< 10 mm), osteoarthritis leads to stenosis of the canal and bony impingement on the cord, causing compression and myelopathy (functional disturbance of the spinal cord). Hypertrophy of the ligamentum flavum can aggravate this effect. Osteophytes in the neural foramina, most commonly between C5 and C6 or C6 and C7, can cause radiculopathy (a nerve root disorder). Sometimes the cord and nerve roots are affected, causing radiculomyelopathy. Manifestations vary according to the neural structures involved but commonly include pain.

Symptoms and Signs

Cord compression commonly causes gradual spastic paresis, paresthesias, or both in the hands and feet and may cause hyperreflexia. Neurologic deficits may be asymmetric, nonsegmental, and aggravated by cough or Valsalva maneuvers. After trauma, people with cervical spondylosis may develop a central cord syndrome (see table Spinal Cord Syndromes).

Eventually, muscle atrophy and flaccid paresis may develop in the upper extremities at the level of the lesion, with spasticity below the level of the lesion.

Nerve root compression commonly causes early radicular pain; later, there may be weakness, hyporeflexia, and muscle atrophy.

Diagnosis

  • MRI or CT

Cervical spondylosis is suspected when characteristic neurologic deficits occur in patients who are elderly, have osteoarthritis, or have radicular pain at the C5 or C6 levels.

Diagnosis of cervical spondylosis is by MRI or CT.

Treatment

  • For cord involvement or refractory radiculopathy, cervical laminectomy

  • For radiculopathy only, nonsteroidal anti-inflammatory drugs (NSAIDs) and a soft cervical collar

For patients with cord involvement, cervical laminectomy is usually needed; a posterior approach can relieve the compression but leaves anterior compressive osteophytes and may result in spinal instability and kyphosis. Thus, an anterior approach with spinal fusion is generally preferred.

Patients with only radiculopathy may try nonsurgical treatment with NSAIDs and a soft cervical collar; if this approach is ineffective, surgical decompression may be required. Indications for surgical decompression include

  • Intractable pain

  • Spinal cord compromise (eg, progressive weakness, bowel and bladder dysfunction)

Baclofen may help relieve spasticity.

Key Points

  • Cervical spondylosis due to osteoarthritis, especially if the cervical canal is congenitally narrow, can lead to stenosis of the canal and development of osteophytes, which may compress the cord or nerve roots.

  • Cord compression commonly causes gradual spastic paresis and/or paresthesias in the hands and feet and may cause hyperreflexia, eventually resulting in muscle atrophy, flaccid paresis, and spasticity; nerve root compression commonly causes early radicular pain, sometimes followed by weakness, hyporeflexia, and muscle atrophy.

  • Diagnose using MRI or CT.

  • If the spinal cord is compressed, do a cervical laminectomy, usually with an anterior approach; for radiculopathy alone, try NSAIDs plus a soft cervical collar, but if this treatment is ineffective, consider surgical decompression.

Click here for Patient Education
NOTE: This is the Professional Version. CONSUMERS: Click here for the Consumer Version
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