Am Fam Physician. 2000;62(5):1073
See related article on cervical spondylotic myelopathy.
What is cervical spondylotic myelopathy?
Cervical spondylotic myelopathy (CSM) is a compression of the spinal cord in the neck. CSM often affects older adults. In people with CSM, changes in the bones, discs and ligaments of the spine cause pressure on the spinal cord. Some changes are because of normal aging. Some changes are caused by arthritis of the spine. CSM is the most common spinal cord problem in people 55 years and older in the United States. If CSM is not treated, it will usually stay the same or get worse. There's no way to tell ahead of time if it will get worse or not.
What are the symptoms of CSM?
CSM develops very slowly. Some symptoms of CSM may include neck stiffness, arm pain, numbness in the hands, and weakness of the arms and legs. A person with CSM may have stiff legs. CSM may make it difficult for a person to use his or her hands or to walk steadily. Other conditions, such as multiple sclerosis, amyotrophic lateral sclerosis and tumors on the spinal cord, can cause similar symptoms.
How is CSM diagnosed?
Your doctor will do a physical exam to see if you have CSM. He or she will look for changes in your strength, reflexes and ability to feel things. A magnetic resonance imaging (MRI) scan can confirm that you have spinal cord compression in your neck. The MRI can also show other problems that have similar symptoms to CSM, like tumors. If your doctor's not sure that you have CSM, he or she can do other tests. Your doctor may also want you to see a neurologist.
How is CSM treated?
Mild cases of CSM can be treated with neck braces or neck traction, but it's not clear if these treatments help in the long run. Surgery to reduce the compression of the spinal cord may help. Unfortunately, surgery doesn't help everyone. There are medicines that can relieve pain caused by CSM, but they don't help the underlying causes of CSM or relieve other symptoms like weakness or numbness.