Cervical spondylotic myelopathy

Cervical spondylotic myelopathy (CSM) refers to impaired function of the spinal cord caused by degenerative changes of the discs and facet joints acquired in adult life. As the impairment to spinal cord function (referred to as “”myelopathy””) progresses, both legs weaken and become progressively spastic. Bowel and bladder sphincter control may then be altered. In advanced cases, gait will become progressively more difficult without aid by a cane or a walker.

In the past, cervical laminectomy (removing the posterior aspects of the spinal canal) to decompress (relieve pressure on) the spinal cord has been the procedure of choice.

However, as previously described, the majority of the abnormal anatomy producing spinal cord compression is located anteriorly to (in front of) the spinal cord itself. This is only indirectly addressed by a cervical laminectomy, with a clear subset of patients either failing to benefit or even getting worse after a laminectomy.

Therefore, depending on the patient’s anatomy, many surgeons prefer anterior decompression of the spinal cord and nerve roots. These procedures are referred to as anterior cervical decompression and spine fusion operations. The surgeon may also use instrumentation (plates and screws) to provide immediate internal support for the cervical spine, and to promote bone graft healing.

  • Recommended only after less invasive, non-surgical treatment options have been exhausted
  • Requires careful diagnosis and physical examination to determine the best course of surgical treatment