Cervical Spondylotic Myelopathy (CSM): A Literature Review

Abstract

Cervical Spondylotic Myelopathy (CSM) is a progressive degenerative condition of the cervical spine leading to spinal cord compression, primarily affecting individuals over the age of 50. This condition is the most common cause of spinal cord dysfunction in adults, characterized by a constellation of motor, sensory, and autonomic disturbances. The pathogenesis of CSM involves a combination of static mechanical compression due to osteophyte formation, disc degeneration, ligamentum flavum hypertrophy, and dynamic factors such as neck movements exacerbating cord impingement. Clinically, patients present with hand clumsiness, gait disturbances, limb weakness, sensory deficits, and in severe cases, spastic paralysis. Diagnosis is established through clinical evaluation and confirmed with imaging modalities such as MRI, which reveals spinal canal stenosis and cord compression. Several clinical scoring systems, including the modified Japanese Orthopaedic Association (mJOA) score, Nurick grade, and Neck Disability Index (NDI), assist in evaluating severity and monitoring progression. Management of CSM depends on symptom severity and neurological impairment. Non-operative treatment, such as physical therapy and pharmacological intervention, may be considered in mild cases. However, surgical decompression either via anterior or posterior approaches is indicated in cases with progressive neurological decline or failure of conservative therapy. Surgical techniques include anterior cervical discectomy and fusion (ACDF), corpectomy, laminectomy, and laminoplasty. Early recognition and intervention are crucial to improving functional outcomes and preventing irreversible neurological deficits. Prognosis varies, with incomplete spinal cord injuries showing more favorable recovery compared to complete injuries. Rehabilitative measures remain vital in maximizing recovery and quality of life in affected individuals.