Diagnostic and Therapeutic Challenges of Cervical Myelopathy

Abstract

ervical myelopathy constitutes the most common cause for nontraumatic spastic paraparesis and quadriparesis in C the United States (7). Clinically, cervical myelopathy is associated with hand clumsiness, gait disturbance, and bowel and bladder dysfunction. Chronic compression and stretching of the cervical spinal cord cause spinal cord impairment (myelopathy). Spinal cord compression can also compromise blood perfusion leading to hypoxia (5) and apoptosis of myelin-forming oligodendrocytes (20, 23). Eventually, spongy degeneration of fiber tracts and loss of anterior horn motoneurons follow (5). Stretch injury leads to neurologic dysfunction by causing membrane damage and conduction loss (18). Clinically, minimally symptomatic cases are treated conservatively with cervical immobilization and nonsteroidal anti-inflammatory drugs. Symptomatic patients commonly undergo surgical decompression and stabilization with favorable results; however, patients with severe myelopathy may only achieve only partial functional recovery (22).