Aging can bring with it a number of degenerative changes in the body, and one common cause of disability in older people is cervical spondylotic myelopathy (CSM). The cervical spine changes with age and advanced degeneration can result in compression of the spinal cord. It is the most common spinal cord ailment in those over 55.
What exactly is CSM?
Degenerative changes in the spine, including its joints, discs, connective tissue and ligaments of the cervical vertebrae is called cervical spondylotic myelopathy. The spinal canal may gradually decrease in diameter or become compressed. Discs between the cervical vertebrae can lose height and also calcify. As these things occur, greater stress is placed on the cartilage and end plates of the vertebrae. Typically, CSM symptoms begin to become noticeable when the spinal cord has degenerated by 30 percent.
What are the symptoms?
The most common symptoms of CSM can include:
- Neck stiffness
- Aching neck
- Arm and shoulder pain
- Tingling or numbness in the arms or hands
- Body stiffness
- Clumsiness when walking
Most often, symptoms develop gradually. Stiffness or weakness in the legs is considered a hallmark symptom of CSM, although many patients do not link leg issues with cervical problems. An experienced physician like NYC Spine Surgeon Dr. Fischer at NYU Langone Medical Center in NYC can properly diagnose conditions like CSM and help patients realize how symptoms can relate to various parts of the body.
How is it diagnosed?
An MRI of the cervical spine is the ideal diagnostic test for CSM. This test provides images that give a thorough view of the spine and spinal cord. A CT scan is another test commonly used along with an MRI because it can provide an accurate view of the degree of spinal canal degeneration. X-rays alone are not typically used to diagnose CSM because they do not offer enough information for proper diagnosis.
Can CSM be treated without surgery?
Patients whose CSM is considered mild may be able to simply follow a “wait and see” approach, with careful monitoring by a professional like Dr. Fischer. Some cases benefit from a variety of nonsurgical treatments such as cervical traction, cervical immobilization, physical therapy or skull traction. The most common conservative treatment is immobilization with the use of a neck brace or collar. However, medical professionals vary in their opinions about nonsurgical CSM treatment, with some advocating earlier surgical treatment. Seeing a qualified and experienced physician like Dr. Fischer at NYU Langone Medical Center is best to learn what approach is best for you.
What if surgery is necessary?
The purpose of CSM surgery is to give the cervical spine elements more room by decompressing the spinal cord. The procedure may be done either from the posterior or anterior of the spine, depending upon each patient’s case. Although it is considered somewhat controversial in the medical world as to surgical versus nonsurgical treatments, many physicians who treat CSM find that surgery is helpful for many patients experiencing symptoms.