Diagnosis and Management of Cervical Spondylosis Clinical Presentation

  • Author: Sandeep S Rana, MD; Chief Editor: Howard A Crystal, MD   more...
 
Updated: May 16, 2011
 

History

The various clinical syndromes seen with cervical spondylosis manifest quite differently.

  • Intermittent neck and shoulder pain, or cervicalgia, is the most common syndrome seen in clinical practice.[2] This can be a frustrating problem for physicians and patients because often the patient has no associated neurologic signs. When neurologic deficits are present, diagnostic imaging can often help define the cause. When they are not present, however, imaging findings are not usually helpful because the incidence of radiologic abnormalities is quite high in persons in this age group, even in asymptomatic patients.
    • A large part of the problem is that the source of pain in this situation is poorly understood. This syndrome is possibly related to compression of the sinovertebral nerves and the medial branches of the dorsal rami in the cervical region.[16]
    • The neck pain experienced with cervical spondylosis is often accompanied by stiffness, with radiation into the shoulders or occiput, that may be chronic or episodic with long periods of remission.[2]
    • One third of patients with cervicalgia due to cervical spondylosis present with headache, and greater than two thirds present with unilateral or bilateral shoulder pain. A significant amount of these patients also present with arm, forearm, and/or hand pain.[16]
  • Another poorly understood clinical syndrome seen with cervical spondylosis is chronic suboccipital headache. Although the C1 thru C3 dermatomes are represented on the head and it would seem likely that occipitoatlantal and atlantoaxial degeneration would cause pain in these areas, no contributions to these joints occur from the dorsal rami of C1-C3. In addition, the greater occipital nerve cannot usually be compressed by bony structures. Regardless, headaches can be the dominant symptom in a patient with degenerative cervical disease. The headaches are usually suboccipital and may radiate to the base of the neck and the vertex of the skull.[16]
  • Perhaps more thoroughly understood than the above-discussed syndromes is radiculopathy associated with cervical spondylosis. The most commonly involved nerve roots are the sixth and seventh nerve roots, which are caused by C5-C6 or C6-C7 spondylosis, respectively. Patients usually present with pain, paresthesias or weakness, or a combination of these symptoms. The vast majority of these patients present without a history of trauma or other recalled precipitated cause. The pain is usually in the cervical region, the upper limb, shoulder, and/or interscapular region. At times, the pain may be atypical and manifest as chest pain (pseudoangina) or breast pain. Usually, the pain is more frequent in the upper limbs than in the neck, although it is frequently present in both areas.[17] Cervical radiculopathy is not usually associated with myelopathy.[2]
  • Cervical spondylotic myelopathy is the most common cause of nontraumatic paraparesis and tetraparesis. The process usually develops insidiously.
    • In the early stages, patients often present with neck stiffness. Patients also may present with stabbing pain in the preaxial or postaxial border of the arms.[10] Patients with a high compressive myelopathy (C3-C5) can present with a syndrome of "numb, clumsy hands," for which the patient describes difficulty writing, a loss of manual dexterity, nonspecific and diffuse weakness, and abnormal sensations.[2] Those patients with a lower myelopathy typically present with a syndrome of weakness, stiffness, and proprioceptive loss in the legs. These patients often exhibit signs of spasticity.
    • Weakness or clumsiness of the hands may be seen in conjunction with weakness in the legs. Motor loss in the hands with relative sparing of the legs, however, is a relatively rare syndrome. Symptoms are commonly asymmetric in the legs.
    • Loss of sphincter control and urinary incontinence are rare; some patients, however, report urinary urgency, frequency, and/or hesitancy.[2, 10]
    • Cervical spondylotic myelopathy significantly affects patients' quality of life. A recent study reported that greater than one third of patients with cervical spondylotic myelopathy have anxious or depressed moods related to their decreased mobility.[18]
  • Another syndrome that may be seen in relation to cervical spondylosis is central cord syndrome. This syndrome typically occurs when an elderly patient experiences an acute hyperextension injury with preexisting acquired stenosis due to ventral osteophytes and infolding of redundant ligamentum flavum, resulting in acute cord compression. Patients usually present with a history of a blow to the forehead. The syndrome consists of greater upper extremity weakness than lower extremity weakness, varying degrees of sensory disturbances below the lesion, and myelopathic findings such as spasticity and urinary retention.[19]
  • Rarely, dysphagia or airway dysfunction has been reported secondary to cervical spondylosis.[20, 21, 22, 23, 24] Dysphagia may occur when large anterior osteophytes cause mechanical compression of the esophagus or periesophageal inflammation causes motion over the osteophytes. Conservative therapy with anti-inflammatory medications and other modalities has been advocated for mild-to-moderate cases of dysphagia, while surgery has been reserved for more severe cases.[22]
Next

Physical

  • Examination findings include neck pain, radicular signs, and myelopathic signs. Patients with neck pain from spondylosis often present with neck stiffness. This is a nonspecific sign, and other causes of neck pain and stiffness (eg, myofascial pain, intrinsic shoulder pathology) must be considered and excluded.
  • If the history is compatible with cervical radiculopathy, carefully search for signs of muscle atrophy in the supraspinatus, infraspinatus, deltoid, triceps, and first dorsal interosseus muscles.
  • Winging of the scapula also may be present because it can occur with C6 or C7 radiculopathy. Palpate all muscles because this may allow earlier detection of wasting than visualization can provide. If weakness is detected in either 1 myotomal distribution or 2-3 peripheral nerves, peripheral nerve injury can likely be excluded as the cause. Muscle testing is important because muscle findings have more specificity than sensory or reflex findings.
  • Perform a detailed sensory and reflex examination in every patient who presents with a history suggestive of cervical spondylosis. Note that radicular findings often do not adhere strictly to textbook dermatomal charts. Patients often experience more pain proximally in their limbs, while, distally, paresthesias dominate.
  • Look for physical evidence of other causes of radiculopathy-type symptoms (eg, tenderness lateral to the neck in the supraclavicular fossa, Tinel sign).
  • The neck compression test (Spurling test or sign), if positive, is useful when assessing a patient for cervical radiculopathy.
    • This test is best performed by having the patient actively extend his or her neck, laterally flex, and rotate to the side of the pain while sitting. Next, use careful compression by slight axial loading. This maneuver works by narrowing the ipsilateral neural foramina during flexion and rotation, while the initial extension causes posterior disk bulging.
    • While this maneuver has a low sensitivity for cervical radiculopathy, it has a specificity of nearly 100%. Other useful tests are the axial manual traction test and the shoulder abduction test.
  • In cervical spondylotic myelopathy, the most typical examination findings are suggestive of upper motor dysfunction, including hyperactive deep tendon reflexes, ankle and/or patellar clonus, spasticity (especially of the lower extremities), the Babinski sign, and the Hoffman sign.
    • The Hoffman sign is a reflex contraction of the thumb and index finger after nipping the middle finger. Although this sign is usually present with corticospinal tract dysfunction, unlike the Babinski sign, it can also be present in generalized hyperreflexic states and in neurosis. It also may be found (usually bilaterally and incomplete) in persons without cervical spondylotic myelopathy.
    • Thus, this sign is only valuable if it is associated with other upper motor neuron–related findings. The Hoffman sign is best elicited by positioning the patient's hand at rest and then stabilizing the proximal phalanx between the examiner's index and middle finger; with the examiner's thumb, the patient's distal middle finger is flicked downward. The sensitivity of this examination maneuver may be increased by examining the patient during multiple full flexions or extensions of the neck (dynamic Hoffman sign).
  • Another occasionally useful test is the pectoralis muscle reflex.
    • This is elicited by tapping the pectoralis tendon in the deltopectoral groove, which causes adduction and internal rotation of the shoulder if hyperactivity is present. A positive result suggests compression in the upper cervical spine (C2-C4).
    • If the patient exhibits diffuse hyperreflexia, then the jaw jerk may distinguish an upper cervical cord compression from lesions that are above the foramen magnum.
  • In patients with cervical spondylotic myelopathy, weakness is most commonly seen in the triceps and/or hand intrinsic muscles, where upper extremity symptoms typically begin. Wasting of the intrinsic hand musculature is also a typical finding.
    • A thorough examination of patients' hands should be performed. By having the patient make a fist and release it 20 times in 10 seconds, impairment or clumsiness may be observed that may suggest cervical spondylotic myelopathy.
    • The finger escape sign may also be present. To assess this, the patient holds his or her fingers extended and adducted. If the ulnar digits drift into abduction and flexion within 30-60 seconds, cervical spondylotic myelopathy may be present.
  • A classic finding with examination of the lower extremities is proximal motor weakness, most commonly in the iliopsoas, followed by the quadriceps femoris; distal weakness is a less common finding. The finding of lower extremity weakness and lower extremity upper motor neuron signs but absent upper extremity symptoms and signs should trigger a workup for thoracic cord pathology.
  • Examine gait during any neurologic examination whenever possible. Patients with cervical spondylotic myelopathy typically exhibit a stiff or spastic gait, especially later in the course of their disease.
  • Another helpful sign is the Lhermitte sign.
    • This consists of electric shock–like sensations that run down the center of the patient's back and shoot into the limbs during flexion of the neck.
    • This sign is not specific for cervical spondylotic myelopathy and classically is attributed to posterior column dysfunction. Other causes of the Lhermitte sign include multiple sclerosis, tumors, and other compressive pathology.
  • Sensory abnormalities in cervical spondylotic myelopathy have a variable pattern upon examination.
    • Loss of vibratory sense or proprioception in the extremities can occur, particularly in the feet. Spinothalamic sensory loss may be asymmetric.
    • Diabetes mellitus or other metabolic causes of peripheral neuropathy can confound the sensory examination. Perform a complete motor examination. Wasting of the intrinsic hand musculature is a classic finding in persons with cervical spondylotic myelopathy.
Previous
Next

Causes

In addition to age and possibly sex, several risk factors have been proposed for cervical spondylosis.

Repeated occupational trauma (eg, carrying axial loads, professional dancing, gymnastics) may contribute. The role of occupational trauma is controversial, especially in terms of worker's compensation claims and other related medicolegal clauses.

Familial cases have been reported; a genetic cause is possible.

Smoking also may be a risk factor.

Conditions that contribute to segmental instability and excessive segmental motion (eg, congenitally fused spine, cerebral palsy, Down syndrome) may be risk factors for spondylotic disease. Cervical spondylotic myelopathy may be responsible for functional declines in patients with athetoid cerebral palsy.

Previous
Proceed to Differential Diagnoses
 
 
Contributor Information and Disclosures
Author

Sandeep S Rana, MD  Clinical Associate Professor of Neurology, Drexel University College of Medicine

Sandeep S Rana, MD is a member of the following medical societies: American Academy of Neurology, American Society of Neuroimaging, and Pennsylvania Medical Society

Disclosure: Nothing to disclose.

Specialty Editor Board

William J Nowack, MD  Associate Professor, Epilepsy Center, Department of Neurology, University of Kansas Medical Center

William J Nowack, MD is a member of the following medical societies: American Academy of Neurology, American Clinical Neurophysiology Society, American Epilepsy Society, American Medical Electroencephalographic Association, American Medical Informatics Association, and Biomedical Engineering Society

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: eMedicine Salary Employment

James H Halsey, MD  Professor, Department of Neurology, University of Alabama Medical Center

James H Halsey, MD is a member of the following medical societies: American Academy of Neurology, American Heart Association, American Medical Association, American Neurological Association, American Society of Neuroimaging, Medical Association of the State of Alabama, New York Academy of Sciences, Pan American Medical Association, Sigma Xi, Society for Neuroscience, and Southern Medical Association

Disclosure: Nothing to disclose.

Selim R Benbadis, MD  Professor, Director of Comprehensive Epilepsy Program, Departments of Neurology and Neurosurgery, Tampa General Hospital, University of South Florida College of Medicine

Selim R Benbadis, MD is a member of the following medical societies: American Academy of Neurology, American Academy of Sleep Medicine, American Clinical Neurophysiology Society, American Epilepsy Society, and American Medical Association

Disclosure: UCB Pharma Honoraria Speaking, consulting; Lundbeck Honoraria Speaking, consulting; Cyberonics Honoraria Speaking, consulting; Glaxo Smith Kline Honoraria Speaking, consulting; Pfizer Honoraria Speaking, consulting; Sleepmed/DigiTrace Honoraria Speaking, consulting

Chief Editor

Howard A Crystal, MD  Professor, Departments of Neurology and Pathology, State University of New York Downstate; Consulting Staff, Department of Neurology, University Hospital and Kings County Hospital Center

Howard A Crystal, MD is a member of the following medical societies: American Academy of Neurology and American Neurological Association

Disclosure: Nothing to disclose.

References

  1. Parke WW. Correlative anatomy of cervical spondylotic myelopathy. Spine (Phila Pa 1976). Jul 1988;13(7):831-7. [Medline].

  2. McCormack BM, Weinstein PR. Cervical spondylosis. An update. West J Med. Jul-Aug 1996;165(1-2):43-51. [Medline].

  3. Wilkinson M. The morbid anatomy of cervical spondylosis and myelopathy. Brain. Dec 1960;83:589-617. [Medline].

  4. Hoff JT, Wilson CB. The pathophysiology of cervical spondylotic radiculopathy and myelopathy. Clin Neurosurg. 1977;24:474-87. [Medline].

  5. Rosomoff HL, Fishbain D, Rosomoff RS. Chronic cervical pain: radiculopathy or brachialgia. Noninterventional treatment. Spine (Phila Pa 1976). Oct 1992;17(10 Suppl):S362-6. [Medline].

  6. Emery SE. Cervical spondylotic myelopathy: diagnosis and treatment. J Am Acad Orthop Surg. Nov-Dec 2001;9(6):376-88. [Medline].

  7. Fehlings MG, Skaf G. A review of the pathophysiology of cervical spondylotic myelopathy with insights for potential novel mechanisms drawn from traumatic spinal cord injury. Spine (Phila Pa 1976). Dec 15 1998;23(24):2730-7. [Medline].

  8. Young WF. Cervical spondylotic myelopathy: a common cause of spinal cord dysfunction in older persons. Am Fam Physician. Sep 1 2000;62(5):1064-70, 1073. [Medline].

  9. McCormick WE, Steinmetz MP, Benzel EC. Cervical spondylotic myelopathy: make the difficult diagnosis, then refer for surgery. Cleve Clin J Med. Oct 2003;70(10):899-904. [Medline].

  10. Young WF, Weaver M, Mishra B. Surgical outcome in patients with coexisting multiple sclerosis and spondylosis. Acta Neurol Scand. Aug 1999;100(2):84-7. [Medline].

  11. al-Mefty O, Harkey HL, Marawi I, et al. Experimental chronic compressive cervical myelopathy. J Neurosurg. Oct 1993;79(4):550-61. [Medline].

  12. Henderson FC, Geddes JF, Vaccaro AR, Woodard E, Berry KJ, Benzel EC. Stretch-associated injury in cervical spondylotic myelopathy: new concept and review. Neurosurgery. May 2005;56(5):1101-13; discussion 1101-13. [Medline].

  13. Moore AP, Blumhardt LD. A prospective survey of the causes of non-traumatic spastic paraparesis and tetraparesis in 585 patients. Spinal Cord. Jun 1997;35(6):361-7. [Medline].

  14. Holt S, Yates PO. Cervical spondylosis and nerve root lesions. Incidence at routine necropsy. J Bone Joint Surg Br. Aug 1966;48(3):407-23. [Medline].

  15. Rahim KA, Stambough JL. Radiographic evaluation of the degenerative cervical spine. Orthop Clin North Am. Jul 1992;23(3):395-403. [Medline].

  16. Heller JG. The syndromes of degenerative cervical disease. Orthop Clin North Am. Jul 1992;23(3):381-94. [Medline].

  17. Ellenberg MR, Honet JC, Treanor WJ. Cervical radiculopathy. Arch Phys Med Rehabil. Mar 1994;75(3):342-52. [Medline].

  18. Stoffman MR, Roberts MS, King JT Jr. Cervical spondylotic myelopathy, depression, and anxiety: a cohort analysis of 89 patients. Neurosurgery. Aug 2005;57(2):307-13; discussion 307-13. [Medline].

  19. Schneider RC, Cherry G, Pantek H. The syndrome of acute central cervical spinal cord injury; with special reference to the mechanisms involved in hyperextension injuries of cervical spine. J Neurosurg. Nov 1954;11(6):546-77. [Medline].

  20. Kaye JJ, Dunn AW. Cervical spondylotic dysphagia. South Med J. May 1977;70(5):613-4. [Medline].

  21. Umerah BC, Mukherjee BK, Ibekwe O. Cervical spondylosis and dysphagia. J Laryngol Otol. Nov 1981;95(11):1179-83. [Medline].

  22. Sobol SM, Rigual NR. Anterolateral extrapharyngeal approach for cervical osteophyte-induced dysphagia. Literature review. Ann Otol Rhinol Laryngol. Sep-Oct 1984;93(5 Pt 1):498-504. [Medline].

  23. Farooqi NA, Doran M, Buxton N. Cervical osteophytes: a cause of potentially life-threatening laryngeal spasms. Case report. J Neurosurg Spine. May 2006;4(5):419-20. [Medline].

  24. Kanbay M, Selcuk H, Yilmaz U. Dysphagia caused by cervical osteophytes: a rare case. J Am Geriatr Soc. Jul 2006;54(7):1147-8. [Medline].

  25. Teresi LM, Lufkin RB, Reicher MA, et al. Asymptomatic degenerative disk disease and spondylosis of the cervical spine: MR imaging. Radiology. Jul 1987;164(1):83-8. [Medline].

  26. Brown BM, Schwartz RH, Frank E, Blank NK. Preoperative evaluation of cervical radiculopathy and myelopathy by surface-coil MR imaging. AJR Am J Roentgenol. Dec 1988;151(6):1205-12. [Medline].

  27. Alexander JT. Natural history and nonoperative management of cervical spondylosis. In: Menezes AH, Sonntag VKH, et al. Principles of Spinal Surgery. Vol 1. 1996:547-557.

  28. Penning L, Wilmink JT, van Woerden HH, Knol E. CT myelographic findings in degenerative disorders of the cervical spine: clinical significance. AJR Am J Roentgenol. Apr 1986;146(4):793-801. [Medline].

  29. Yamazaki T, Suzuki K, Yanaka K, Matsumura A. Dynamic computed tomography myelography for the investigation of cervical degenerative disease. Neurol Med Chir (Tokyo). Apr 2006;46(4):210-5; discussion 215-6. [Medline].

  30. Song T, Chen WJ, Yang B, et al. Diffusion tensor imaging in the cervical spinal cord. Eur Spine J. Mar 2011;20(3):422-8. [Medline].

  31. Iwabuchi M, Kikuchi S, Sato K. Pathoanatomic investigation of cervical spondylotic myelopathy. Fukushima J Med Sci. Dec 2004;50(2):47-54. [Medline].

  32. Gore DR, Sepic SB, Gardner GM, Murray MP. Neck pain: a long-term follow-up of 205 patients. Spine (Phila Pa 1976). Jan-Feb 1987;12(1):1-5. [Medline].

  33. AGS Panel on Persistent Pain in Older Persons. The management of of persistent pain in older persons. J Am Geriatr Soc. 2002;50(Suppl 6):S205-S224.

  34. Swezey RL, Swezey AM, Warner K. Efficacy of home cervical traction therapy. Am J Phys Med Rehabil. Jan-Feb 1999;78(1):30-2. [Medline].

  35. Kaiser MG, Haid RW, Subach BR, Barnes B, Rodts GE Jr. Anterior cervical plating enhances arthrodesis after discectomy and fusion with cortical allograft. Neurosurgery. Feb-2002;50:229-236.

  36. Baskin DS, Ryan P, Sonnta V, Westmark R, Wedmayer MA. A prospective, randomized, controlled cervical fusion study using recombinant human bone morphogentic protein-2 with the CORNERSTONE-SR allograft ring and the ATLANTIS anterior cervical plate. Spine. 2003;28:1219-1225.

  37. Rowland LP. Surgical treatment of cervical spondylotic myelopathy: time for a controlled trial. Neurology. Jan 1992;42(1):5-13. [Medline].

  38. Nurick S. The natural history and the results of surgical treatment of the spinal cord disorder associated with cervical spondylosis. Brain. 1972;95(1):101-8. [Medline].

  39. Fouyas IP, Statham PF, Sandercock PA. Cochrane review on the role of surgery in cervical spondylotic radiculomyelopathy. Spine (Phila Pa 1976). Apr 1 2002;27(7):736-47. [Medline].

  40. Kadanka Z, Mares M, Bednaník J, et al. Approaches to spondylotic cervical myelopathy: conservative versus surgical results in a 3-year follow-up study. Spine (Phila Pa 1976). Oct 15 2002;27(20):2205-10; discussion 2210-1. [Medline].

  41. Sampath P, Bendebba M, Davis JD, Ducker TB. Outcome of patients treated for cervical myelopathy. A prospective, multicenter study with independent clinical review. Spine (Phila Pa 1976). Mar 15 2000;25(6):670-6. [Medline].

  42. Ma X, Zhao XF, Zhao YB. [A clinical study on different decompression methods in cervical spondylosis]. Zhonghua Wai Ke Za Zhi. Apr 15 2009;47(8):607-9. [Medline].

  43. Lee JY, Sharan A, Baron EM, et al. Quantitative prediction of spinal cord drift after cervical laminectomy and arthrodesis. Spine (Phila Pa 1976). Jul 15 2006;31(16):1795-8. [Medline].

  44. Wang MY, Shah S, Green BA. Clinical outcomes following cervical laminoplasty for 204 patients with cervical spondylotic myelopathy. Surg Neurol. Dec 2004;62(6):487-92; discussion 492-3. [Medline].

  45. Kaminsky SB, Clark CR, Traynelis VC. Operative treatment of cervical spondylotic myelopathy and radiculopathy. A comparison of laminectomy and laminoplasty at five year average follow-up. Iowa Orthop J. 2004;24:95-105. [Medline].

  46. Grob D. Surgery in the degenerative cervical spine. Spine (Phila Pa 1976). Dec 15 1998;23(24):2674-83. [Medline].

  47. Kumar VG, Rea GL, Mervis LJ, McGregor JM. Cervical spondylotic myelopathy: functional and radiographic long-term outcome after laminectomy and posterior fusion. Neurosurgery. Apr 1999;44(4):771-7; discussion 777-8. [Medline].

  48. Houten JK, Cooper PR. Laminectomy and posterior cervical plating for multilevel cervical spondylotic myelopathy and ossification of the posterior longitudinal ligament: effects on cervical alignment, spinal cord compression, and neurological outcome. Neurosurgery. May 2003;52(5):1081-7; discussion 1087-8. [Medline].

  49. Huang RC, Girardi FP, Poynton AR, Cammisa Jr FP. Treatment of multilevel cervical spondylotic myeloradiculopathy with posterior decompression and fusion with lateral mass plate fixation and local bone graft. J Spinal Disord Tech. Apr 2003;16(2):123-9. [Medline].

  50. Chagas H, Domingues F, Aversa A, Vidal Fonseca AL, de Souza JM. Cervical spondylotic myelopathy: 10 years of prospective outcome analysis of anterior decompression and fusion. Surg Neurol. 2005;64 Suppl 1:S1:30-5; discussion S1:35-6. [Medline].

  51. Chibbaro S, Benvenuti L, Carnesecchi S, et al. Anterior cervical corpectomy for cervical spondylotic myelopathy: experience and surgical results in a series of 70 consecutive patients. J Clin Neurosci. Feb 2006;13(2):233-8. [Medline].

  52. Macdonald RL, Fehlings MG, Tator CH, et al. Multilevel anterior cervical corpectomy and fibular allograft fusion for cervical myelopathy. J Neurosurg. Jun 1997;86(6):990-7. [Medline].

  53. Santiago P, Fessler RG. Minimally Invasive Surgery for the Management of cervical spondylosis. Neurosurgery. Jan-2007;60:S1-160-165.

  54. Razack N, Greenberg J, Green BA. Surgery for cervical myelopathy in geriatric patients. Spinal Cord. Sep 1998;36(9):629-32. [Medline].

  55. Murphey F, Simmons JC, Brunson B. Chapter 2. Ruptured cervical discs, 1939 to 1972. Clin Neurosurg. 1973;20:9-17. [Medline].

  56. Whitecloud TS 3rd, Seago RA. Cervical discogenic syndrome. Results of operative intervention in patients with positive discography. Spine (Phila Pa 1976). May 1987;12(4):313-6. [Medline].

  57. Bracken MB, Shepard MJ, Collins WF Jr, et al. Methylprednisolone or naloxone treatment after acute spinal cord injury: 1-year follow-up data. Results of the second National Acute Spinal Cord Injury Study. J Neurosurg. Jan 1992;76(1):23-31. [Medline].

  58. Chesnut RM, Abitbol JJ, Garfin SR. Surgical management of cervical radiculopathy. Indication, techniques, and results. Orthop Clin North Am. Jul 1992;23(3):461-74. [Medline].

  59. Chiles BW 3rd, Leonard MA, Choudhri HF, Cooper PR. Cervical spondylotic myelopathy: patterns of neurological deficit and recovery after anterior cervical decompression. Neurosurgery. Apr 1999;44(4):762-9; discussion 769-70. [Medline].

  60. Clarke E, Robinson PK. Cervical myelopathy: a complication of cervical spondylosis. Brain. Sep 1956;79(3):483-510. [Medline].

  61. Clements DH, O'Leary PF. Anterior cervical discectomy and fusion. Spine (Phila Pa 1976). Oct 1990;15(10):1023-5. [Medline].

  62. Connor PM, Darden BV 2nd. Cervical discography complications and clinical efficacy. Spine (Phila Pa 1976). Oct 15 1993;18(14):2035-8. [Medline].

  63. Cull R, Whittle I. The nervous system. In: Munro J, Edwards CS. Macleod's Clinical Examination. 1995:201-256.

  64. Denno JJ, Meadows GR. Early diagnosis of cervical spondylotic myelopathy. A useful clinical sign. Spine (Phila Pa 1976). Dec 1991;16(12):1353-5. [Medline].

  65. Dillin W, Booth R, Cuckler J, Balderston R, Simeone F, Rothman R. Cervical radiculopathy. A review. Spine (Phila Pa 1976). Dec 1986;11(10):988-91. [Medline].

  66. Dillin W, Uppal GS. Analysis of medications used in the treatment of cervical disk degeneration. Orthop Clin North Am. Jul 1992;23(3):421-33. [Medline].

  67. Durufle A, Petrilli S, Le Guiet JL, et al. Cervical spondylotic myelopathy in athetoid cerebral palsy patients: about five cases. Joint Bone Spine. May 2005;72(3):270-4. [Medline].

  68. Ebara S, Yonenobu K, Fujiwara K, Yamashita K, Ono K. Myelopathy hand characterized by muscle wasting. A different type of myelopathy hand in patients with cervical spondylosis. Spine (Phila Pa 1976). Jul 1988;13(7):785-91. [Medline].

  69. Firooznia H, Ahn JH, Rafii M, Ragnarsson KT. Sudden quadriplegia after a minor trauma. The role of preexisting spinal stenosis. Surg Neurol. Feb 1985;23(2):165-8. [Medline].

  70. Goodridge AE, Feasby TE, Ebers GC, Brown WF, Rice GP. Hand wasting due to mid-cervical spinal cord compression. Can J Neurol Sci. Aug 1987;14(3):309-11. [Medline].

  71. Haerer AF. Examination in cases of suspected hysteria and malingering. In: DeJong's The Neurologic Examination. 5th ed. 1992:744.

  72. Haldeman S, Kohlbeck FJ, McGregor M. Risk factors and precipitating neck movements causing vertebrobasilar artery dissection after cervical trauma and spinal manipulation. Spine (Phila Pa 1976). Apr 15 1999;24(8):785-94. [Medline].

  73. Irvine DH, Foster JB, Newell DJ, Klukvin BN. Prevalence of cervical spondylosis in a general practice. Lancet. May 22 1965;14:1089-92. [Medline].

  74. Jumah KB, Nyame PK. Relationship between load carrying on the head and cervical spondylosis in Ghanaians. West Afr J Med. Jul-Sep 1994;13(3):181-2. [Medline].

  75. Kaiser JA, Holland BA. Imaging of the cervical spine. Spine (Phila Pa 1976). Dec 15 1998;23(24):2701-12. [Medline].

  76. LaBan MM, Taylor RS. Manipulation: an objective analysis of the literature. Orthop Clin North Am. Jul 1992;23(3):451-9. [Medline].

  77. Lam M. Headache. In: Adler SN, et al. A Pocket manual of Differential Diagnosis. 1994:303-304.

  78. LaRocca H. Cervical spondylotic myelopathy: natural history. Spine (Phila Pa 1976). Jul 1988;13(7):854-5. [Medline].

  79. Lees F, Turner J. Natural history and prognosis of cervical spondylosis. BMJ. 1963;2:1603.

  80. Nakano KK. Neck pain. In: Kelley WN, Harris ED, Ruddy S, Sledge CB. Textbook of Rheumatology. 1985:471-490.

  81. Ono K, Ebara S, Fuji T, Yonenobu K, Fujiwara K, Yamashita K. Myelopathy hand. New clinical signs of cervical cord damage. J Bone Joint Surg Br. Mar 1987;69(2):215-9. [Medline].

  82. Papadopoulos SM, Hoff JT. Anatomical treatment of cervical spondylosis. Clin Neurosurg. 1994;41:270-85. [Medline].

  83. Phillips DG. Surgical treatment of myelopathy with cervical spondylosis. J Neurol Neurosurg Psychiatry. Oct 1973;36(5):879-84. [Medline].

  84. Raynor RB, Pugh J, Shapiro I. Cervical facetectomy and its effect on spine strength. J Neurosurg. Aug 1985;63(2):278-82. [Medline].

  85. Robinson R, Smith G. Anterolateral cervical disc removal and interbody fusion for cervical disc syndrome. Bull Johns Hopkins Hosp. 1955;96:223.

  86. Saunders R. Corpectomy for cervical spondylotic myelopathy. In: Menezes AH, Sonntag VH, et al. Principles of Spinal Surgery. Vol. 1. 1996:559-569.

  87. Schellhas KP, Smith MD, Gundry CR, Pollei SR. Cervical discogenic pain. Prospective correlation of magnetic resonance imaging and discography in asymptomatic subjects and pain sufferers. Spine (Phila Pa 1976). Feb 1 1996;21(3):300-11; discussion 311-2. [Medline].

  88. Tan JC, Nordin M. Role of physical therapy in the treatment of cervical disk disease. Orthop Clin North Am. Jul 1992;23(3):435-49. [Medline].

  89. Verbiest H. Chapter 23. The management of cervical spondylosis. Clin Neurosurg. 1973;20:262-94. [Medline].

  90. Viikari-Juntura E, Porras M, Laasonen EM. Validity of clinical tests in the diagnosis of root compression in cervical disc disease. Spine (Phila Pa 1976). Mar 1989;14(3):253-7. [Medline].

  91. Watson JC, Broaddus WC, Smith MM, Kubal WS. Hyperactive pectoralis reflex as an indicator of upper cervical spinal cord compression. Report of 15 cases. J Neurosurg. Jan 1997;86(1):159-61. [Medline].

  92. Yoo K, Origitano TC. Familial cervical spondylosis. Case report. J Neurosurg. Jul 1998;89(1):139-41. [Medline].

  93. Yoss RE, Corbin KB, Maccarty CS, Love JG. Significance of symptoms and signs in localization of involved root in cervical disk protrusion. Neurology. Oct 1957;7(10):673-83. [Medline].

 
Previous
Next
 
A 48-year-old man presented with neck pain and predominantly left-sided radicular symptoms in the arm. The patient's symptoms resolved with conservative therapy. T2-weighted sagittal MRI shows ventral osteophytosis, most prominent between C4 and C7, with reduction of the ventral cerebrospinal fluid sleeve.
A 48-year-old man presented with neck pain and predominantly left-sided radicular symptoms in the arm. The patient's symptoms resolved with conservative therapy. Axial gradient echo MRI shows moderate anteroposterior narrowing of the cord space due to a ventral osteophyte at the C4 level, with bilateral narrowing of the neural foramina (more prominently on the left side).
A 48-year-old man presented with neck pain and predominantly left-sided radicular symptoms in the arm. The patient's symptoms resolved with conservative therapy. Axial CT scan at C5-6 demonstrates a large ventral osteophyte (see arrow). In addition, uncinate process hypertrophy is present bilaterally and the right neural foramen is narrowed.
T2-weighted sagittal MRI of a 59-year-old woman who presented with a spastic gait and weakness in her upper extremities showing cord compression from cervical spondylosis, which caused central spondylotic myelopathy. Note the signal changes in the cord at C4-C5, the ventral osteophytosis, buckling of the ligamentum flavum at C3-C4, and the prominent loss of disk height between C2 and C5.
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2012 by WebMD LLC.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.