What is Cervical Spondylotic Myelopathy?
Cervical spondylotic myelopathy (CSM) is one of the most common reasons that spinal cord dysfunction occurs in elderly patients. As we all know, the spinal cord is one of the most important structures in the human body. Damage to this structure in any way, shape, or form may result in a cascade of symptoms. This is only natural, of course, as the spinal cord is the main neural thoroughfare for transmitting messages from the brain to the rest of the body.
To understand CSM, we will need to break down the medical vernacular that exists within the name. To start, the cervical spine describes the portion of the spine that is located in the neck. So, this tells us that this particular condition occurs in this region of the spinal cord. Myelopathy describes any damage to the spinal cord, which may arise for a variety of different causes. Typically speaking, damage to the spinal cord occurs when the spine becomes compressed or squeezed. This abnormality disrupts the ability of nerves to transmit messages to other areas of the body. Lastly, spondylosis describes any age-related wear and tear that occurs naturally in the spine. So, conditions such as osteoarthritis, disc degeneration, and herniated discs come to mind.
To review, this means that CSM describes damage to the cervical spine that is a direct result of age-related wear and tear. Due to the nature of this condition, we know that this affects the way that branching nerves transmit messages to other parts of the body. Therefore, CSM often results in pain, weakness, and tingling in areas such as the arms and legs as well as the neck.
Cervical Spondylotic Myelopathy (CSM) Causes & Risk Factors
Based on the information above, we know that CSM is a sort of blanket term that describes damage to the cervical spine resulting from some manner of pre-existing medical condition. There are a lot of different conditions that contribute to the structural damage of the cervical spine. Here is a list of some common conditions that may lead to CSM:
- Bone Spurs: Bone spurs are often the result of the body reacting to a condition known as osteoarthritis. Basically, bone spurs are small bony bumps that form around the discs as they lose their water content through the natural aging process. Bone spurs form to strengthen the now weakened structures of the spine, but unfortunately it doesn’t pan out all that well. Instead, bone spurs tend to press on adjacent nerve roots and the spinal cord itself, causing pain.
- Disc Herniation: The spinal discs are like jelly donuts with a soft inner material and a harder outer shell. Over time, the outer ring wears down as either a natural result of physics or through traumatic injury. When this happens, the softer inner material may push out of the harder outer shell and press on nearby nerve root endings. This results in pain and discomfort for the patient.
- Rheumatoid Arthritis: This condition is different from other forms of arthritis because it is technically an autoimmune disease. This translates to the body’s immune system attacking its own tissues as a result of the condition. More specifically, the condition targets the membrane that lines the facet joints of the cervical spine. This membrane swells as a result, which reduces the amount of space available in the immediate area of the spinal cord.
The Symptoms of Cervical Spondylotic Myelopathy (CSM)
CSM does not really have a sudden onset in most cases, though the rate at which symptoms exacerbate is variable across individual cases. Most of the time, the symptoms manifest slowly and progress at a steady rate over a period of time (generally a few years).
Patients with the condition may experience one or more of the following symptoms:
- Sensations of tingling or numbness in the extremities
- Muscle weakness that progresses over a period of time. Usually this occurs in the arms, shoulders, or hands. As a result, patients often find that they have trouble performing basic everyday activities such as lifting or gripping objects.
- Many patients report that they have trouble walking or difficulty keeping balance. There is, however, a distinction between this sensation and vertigo. Instead of feeling dizzy, patients find that there is an unnatural dissonance between the position of the head in relation to the body.
- CSM also causes a loss of fine motor skills, which means that patients will have trouble performing activities such as writing, eating, and grasping objects, etc.
- Lastly, as you might expect, CSM causes pain or stiffness in the cervical spine.
Doctors diagnose CSM by starting with a review of your medical history and a physical examination. Your doctor will likely ask you about the nature of your symptoms, as well as other questions involving pre-existing medical conditions, family history, and more. Doctors typically look for abnormalities with your reflexes, loss of sensation in the extremities, and difficulty walking.
If a doctor is suspicious that the patient has CSM, they may order one of the following tests:
- X-ray imaging
- MRI scans
- CT scans
Treatment Options for CSM
In mild manifestations of CSM, many doctors will push for a conservative care plan. In most cases, doctors try to exhaust all nonsurgical methods before considering a surgical route for the patient. For conservative treatment, the options are generally:
- Padded Neck Collar: A padded cervical collar is helpful to reduce neck motion. This in turn allows the muscles of the neck to rest as they are held in place. This, however, should only be used as a temporary measure, as prolonged use of a neck collar may weaken the muscles of the neck over time.
- Physical Therapy: Certain exercises are great for increasing the strength of your neck muscles, which helps to increase the patient’s flexibility and range of motion. This will also train the muscles to endure the everyday forces that daily activities can exert on the neck.
- Medication: There are a lot of possible medications that doctors may prescribe for CSM. NSAIDs are a popular form of treatment, but oral corticosteroids, epidural injections, and narcotics are also effective in alleviating the symptoms of CSM.
If conservative methods are not enough to alleviate your symptoms, your doctor will recommend surgery. The type of procedure that your doctor will recommend will depend on the nature and location of your CSM. Surgeons may perform a discectomy and fusion using an anterior approach, or they may try a posterior approach with a laminectomy. It all depends on the severity of your case and the specific elements that surround your condition. For more information, make sure to communicate with your doctor so that you can learn all you can about what is right for you.
If you are experiencing pain or stiffness in the neck that does not get better over time, consider contacting The Advanced Spine Center at (973) 538-0900. Our team of doctors are leading experts in state-of-the-art surgical management and conservative treatment care plans. It is our mission to ensure that every patient is put on a care plan that suits the specific needs of their individual cases. Contact us today!