Cervical myelopathy is a common degenerative condition caused by compression on the spinal cord that is characterized by clumsiness in hands and gait imbalance

Etiology

• degenerative cervical spondylosis (CSM) 

  • most common cause of cervical myelopathy

  • compression usually caused by anterior degenerative changes (osteophytes, discosteophyte complex) 

  • degenerative spondylolisthesis and hypertrophy of ligamentum flavum may contribute

• congenital stenosis

  • symptoms usually begin when congenital narrowing combined with spondylotic degenerative changes in older patients

• Ossification of the posterior longitudinal ligament 

• tumor

• epidural abscess 

• trauma

• cervical kyphosis

Neurologic injury

• mechanism of injury can be

  • direct cord compression

  • ischemic injury secondary to compression of anterior spinal artery

Natural history 

• tends to be slowly progressive and rarely improves with nonoperative modalities

• progression characterized by steplike deterioration with periods of stable symptoms

Symptoms and clinical findings

• Neck stiffness and pain

• extremity paresthesia

• weakness and clumsiness

• gait instability

• urinary retention

• hyperreflexia

• Hoffman’s sign

• Babinski sign

• Romberg test: patient stands with arms held forward and eyes closed. Loss of balance consistent with posterior column dysfunction