The Spine Journal
Volume 3, Issue 1 , Pages 68-81 , January 2003

Cervical myelopathy: current diagnostic and treatment strategies

  • Charles C Edwards II, MD

      Affiliations

    • Maryland Spine Center, Mercy Hospital, 301 St. Paul Place, Baltimore, MD 21202 USA
    • ,
  • K.Daniel Riew, MD

      Affiliations

    • Department of Orthopedic Surgery, Washington University, 660 S. Euclid, St. Louis, MO 63110-1010 USA
    • ,
  • Paul A Anderson, MD

      Affiliations

    • Orthopedic Surgery and Rehabilitation Medicine, Spine Medicine, University of Wisconsin Medical School, Research Park Clinic–Spine Medicine, 621 Science Drive, Madison, WI 53711-1074 USA
    • ,
  • Alan S Hilibrand, MD

      Affiliations

    • The Rothman Institute and Jefferson Medical College, 925 Chestnut Street, 5th Floor, Philadelphia, PA 19107-4216 USA
    • ,
  • Alexander F Vaccaro, MD

      Affiliations

    • Corresponding Author InformationCorresponding author. Alexander R. Vaccaro, MD, The Rothman Institute, 925 Chestnut Street, 5th Floor, Philadelphia, PA 19107, USA. Tel.: (215) 955-5367; fax: (215) 503-0580
    • The Rothman Institute and Jefferson Medical College, 925 Chestnut Street, 5th Floor, Philadelphia, PA 19107-4216 USA

Received 3 July 2002 ,Accepted 23 September 2002.

References 

  1. Payne E, Spillane J. The cervical spine, an anatomicopathological study of 70 specimens (using a special technique) with particular reference to the problem of cervical spondylosis. Brain. 1957;80:571–576
  2. Bernhardt M, Hynes RA, Blume HW, et al.  Cervical spondylotic myelopathy. J Bone Joint Surg. 1993;75A:119–126 [Current concepts review]
  3. Arnold JG. The clinical manifestations of spondylochondrosis (spondylosis) of the cervical spine. Ann Surg. 1955;141:872–889
  4. Boijsen E. The cervical spinal canal in intraspinal expansive processes. ACTA Radiol. 1954;42:101–115
  5. Wilkinson HA, LeMay ML, Ferris EJ. Roentgenographic correlations in cervical spondylosis. Am J Roentgenol. 1969;105:370–374
  6. Pavlov H, Torg JS, Robie R, et al.  Cervical spinal stenosis (determination with vertebral body ratio method). Radiology. 1987;164:171–175
  7. Parke W. Correlative anatomy of cervical spondylotic myelopathy. Spine. 1988;13:831–837
  8. Boden SD, McCowin PR, Davis DO, et al.  Abnormal magnetic-resonance scans of the lumbar spine in asymptomatic subjects. A prospective investigation. J Bone Joint Surg. 1990;72(3):403–408 [Am]
  9. Epstein JA, Carras R, Epstein BS, et al.  Myelopathy in cervical spondylosis with vertebral subluxation and hyperlordosis. J Neurosurg. 1970;32:421–426
  10. Brain WR, Northfield D, Wilkinson M. The neurological manifestations of cervical spondylosis. Brain. 1952;75:187–225
  11. Fukui K, Kataoka O, Sho T, et al.  Pathomechanism, pathogenesis and results of treatment in cervical myelopathy caused by dynamic canal stenosis. Spine. 1990;15:1148–1152
  12. Panjabi MM. Biomechanical evaluation of spinal fixation devices (1. A conceptual framework). Spine. 1988;13:1129–1134
  13. Murone I. The importance of the sagittal diameters of the cervical spine canal in relation to spondylosis and myelopathy. J Bone Joint Surg. 1974;56B:30
  14. Ono K, Ota H, Toda K, et al.  Cervical myelopathy secondary to multiple spondylotic protrusions. A clinicopathologic study. Spine. 1977;2:109–125
  15. Ogino H, Tada K, Okada K. Canal diameter, anterior posterior compression ratio and spondylotic myelopathy of the cervical spine. Spine. 1983;8:1–15
  16. Bohlman HH, Bahnuil E, Raskulinecz G, et al.  Mechanical factors affecting recovery from incomplete cervical spinal cord injury (a preliminary report). Johns Hopkins Med J. 1979;145:115–125
  17. Turnbull IM. Microvasculature of the human spinal cord. J Neurosurg. 1971;35:141–147
  18. Adams C, Logue B, Valentine T. Studies in cervical spondylotic myelopathy. II The movement and contour of the spine in relation to the neural complications of cervical spondylosis. Brain. 1971;94:569–586
  19. Epstein NE, Epstein JA, Carras R. Coexisting cervical and lumbar spinal stenosis (diagnosis and management). Neurosurgery. 1984;15:489–496
  20. Nurick S. The natural history and the results of surgical treatment of the spinal cord disorder associated with cervical spondylosis. Brain. 1972;95(1):101–108
  21. Hirabayashi K, Miyakawa J, Satami K, et al.  Operative results and postoperative progression of ossification among patients with ossification of cervical posterior longitudinal ligament. Spine. 1981;6(4):354–364
  22. Hirabayashi K, Satomi K. Operative procedure and results of expansive open door laminoplasty. Spine. 1988;13(7):870–876
  23. Gruninger W, Gruss P. Stenosis and movement of the cervical spine in cervical myelopathy. Paraplegia. 1982;20:121–130
  24. Brown BM, Schwartz RH, Frank E. Presurgical evaluation of cervical radiculopathy and myelopathy by surface coil MR imaging. Am J Radiol. 1988;151:1205–1212
  25. Morio Y, Tesji R, Nagashima H, et al.  Correlation between operative outcomes of cervical compression myelopathy and MRI of the spinal cord. Spine. 2001;26:1238–1245
  26. Clark E, Robinson PK. Cervical myelopathy (a complication of cervical spondylosis). Brain. 1956;79:483–510
  27. Lees F, Turner JW. Natural history and prognosis of cervical spondylosis. Br Med J. 1963;2:1607–1610
  28. Phillips DG. Surgical treatment of myelopathy with cervical spondylosis. J Neurol Neurosurg Psychiat. 1973;36:879–884
  29. Roberts AH. Myelopathy due to cervical spondylosis treated by collar immobilization. Neurology. 1966;16:951–959
  30. Heller J. The syndromes of degenerative cervical disease. Orthop Clin North Am. 1992;23:381–394
  31. Fujiwara K, Yonenobu K, Ebara S. The prognosis of surgery for cervical compressive myelopathy (an analysis of factors involved). J Bone Joint Surg. 1989;71B:393–398
  32. Kandanka Z, Bednarik J, Vohanka S. Conservative treatment versus surgery in spondylotic cervical myelopathy (a prospective randomized study). Eur Spine J. 2000;9:538–544
  33. Sampath P, Bendebba M, Davis JD, Ducker TB, et al.  Outcome of patients treated for cervical myelopathy (a prospective, multicenter study with independent clinical review). Spine. 2000;25:670–676
  34. Kohno K, Kumon Y, Oka Y. Evaluation of prognostic factors following expansive laminoplasty for cervical spinal stenotic myelopathy. Surg Neurol. 1997;48:237–245
  35. McDonald RL, Fehlings MG, Tator CH. Multilevel anterior cervical corpectomy and fibular allograft fusion for cervical myelopathy. J Neurosurg. 1997;86:990–997
  36. Lesoin F, Bouasakao N, Clarisse J. Results of surgical treatment of radiculomyelopathy caused by cervical arthrosis based on 1000 operations. Sur Neurol. 1985;23:350–355
  37. Boden SD, McCowin PR, Davis DO. Abnormal magnetic-resonance scans of the cervical spine in asymptomatic subjects (a prospective investigation). J Bone Joint Surg. 1990;72A:1178–1184
  38. Swank M, Lowery G, Bhat A. Improved arthrodesis with strut-grafting and instrumentation (multi-level interbody grafting or strut graft reconstruction). Eur Spine J. 1997;6:138–143
  39. Vaccaro AR, Falatyn SP, Scuderi GJ. Early failure of long segment anterior cervical plate fixation. J Spinal Disord. 1998;11:410–415
  40. Hilibrand A, Fye M, Emery S. Improved arthrodesis with strut-grafting after multi-level anterior cervical decompression. Spine. 2002;27:146–151
  41. Bailey R, Badgley C. Stabilization for the cervical spine by anterior fusion. J Bone Joint Surg. 1960;42A:565–594
  42. Smith GW, Robinson RA. The treatment of certain cervical-spine disorders by anterior removal of the intervertebral disc and interbody fusion. J Bone Joint Surg. 1958;40A(3):607–623
  43. Cloward R. The anterior approach for removal of ruptured cervical discs. J Neurosurg. 1958;15:602–617
  44. Bosacco D, Berman A, Levenberg R. Surgical results in anterior cervical discectomy and fusion using a countersunk interlocking autogenous iliac bone graft. Orthopedics. 1992;15:923–925
  45. Emery S, Bolesta MJ, Banks M. The Robinson anterior cervical fusion (comparison of the standard and modified techniques). Spine. 1994;19:660–666
  46. Zdeblick TA, Ducker TB. The use of freeze-dried allograft bone for anterior cervical fusions. Spine. 1991;16(7):726–729
  47. Bohlman HH. Cervical spondylosis with moderate to severe myelopathy (a report of 17 cases treated by Robinson anterior cervical discectomy and fusion). Spine. 1977;2:151–162
  48. Kadoya S, Nakamura T, Kwar R. A microsurgical anterior osteophytectomy for cervical spondylotic myelopathy. Spine. 1984;9:437–443
  49. Kawaguchi Y, Kanamori M, Hirokazu I. Minimum 10-year follow-up after en block cervical laminoplasty. Cervical Spine Research Society; November 30–December 2, 2000; Charleston, SC.
  50. Zhang Z, Yin H, Yang K. Anterior intervertebral disc excision and bone grafting in cervical spondylotic myelopathy. Spine. 1983;5:16–19
  51. Emery SE, Bolesta MJ, Banks MA, Jones PK, et al.  Robinson anterior cervical fusion comparison of the standard and modified techniques. Spine. 1994;19(6):660–663
  52. Wang JC, et al.  Increased fusion rates with cervical plating for two-level anterior cervical discectomy and fusion. Spine. 2000;25(1):41–45
  53. Geck M, Wang JL, Delamarter RB. ACDF with and without plates in 205 patients: results and adjacent segment disease. Proceedings of the North American Spine Society; October 25–28, 2000; New Orleans, LA:10.
  54. An HS, Gordin R, Renner K. Anatomic considerations for plate-screw fixation of the cervical spine. Spine. 1991;16(105):548–551
  55. Grubb MR, Currier BL, Shih JS. Biomechanical evaluation of anterior cervical spine stabilization. Spine. 1998;15:886–892
  56. Katsuura A, Hakuda S, Imanaka T, et al.  Anterior cervical plate used in degenerative disease can maintain cervical lordosis. J Spinal Dis. 1996;9:470–476
  57. Foley KM, Diangelo D, Rampersaud YR. The in vitro effects on instrumentation on multilevel cervical strut-graft mechanics. Spine. 1999;24:2366–2376
  58. Riew KD, Sethi NS, Devney J, et al.  Complications of buttress plate stabilization of cervical corpectomy. Spine. 1999;24(22):2404–2410
  59. DiAngelo D, Foley K, Liu W. In vitro comparison of a translational anterior cervical plate with a constrained anterior cervical plate. Proceedings of the North American Spine Society; October 31–November 3, 2001; Seattle, WA.
  60. Epstein N. Anterior cervical discectomy and fusion without plate instrumentation in 178 patients. J Spinal Disord. 2000;13:1–8
  61. Truumees E, Herkowitz HN. Cervical spondylotic myelopathy and radiculopathy. In Instructional Course Lectures, American Association of Orthopedic Surgeons, 2000:339–60.
  62. Capen DA, Garland DE, Waters RL. Surgical stabilization of the cervical spine (a comparative analysis of anterior and posterior spine fusions). Clin Orthop Rel Res. 1985;196:229–237
  63. Clements D, O'Leary P. Anterior cervical discectomy and fusion. Spine. 1990;15:1023–1025
  64. Welch LW, Welsh JJ. Chinnici JC. Dysphagia due to cervical spine surgery. Ann Otol Rhinol Laryngol. 1987;96:112–115
  65. Aflebaum R, Kriskivich M, Heller H. On the incidence, cause and prevention of recurrent laryngeal nerve palsies during anterior cervical spine surgery. Spine 2000;22:2906–212.
  66. Heeneman H. Vocal cord paralysis following approaches to the anterior cervical spine. Laryngoscope. 1973;83:17–21
  67. Butler W, Sweeney C, Conolly P. Recurrent laryngeal nerve injury with anterior cervical spine surgery: risk of laterality of surgical approach. Proceedings of the Cervical Spine Research Society; November 30–December 2, 2000.
  68. Harris MB, Melamed H, Awasthi D. The anatomical considerations of the superior laryngeal nerve during anterior cervical spine procedures. Cervical Spine Research Society; 2000; Charleston, SC.
  69. Burke JP, Gertzen PC, Welch WC. Iatrogenic vertebral artery injury during anterior cervical spine surgery. Presented at the NASS Annual Meeting, 2001, Seattle, WA.
  70. Thomas G, Anderson K, Hain R. The significance of anomalous vertebral-basilar communications in operations on the heart and great vessels (an illustrative case with review of the literature). Surgery. 1959;46:747–759
  71. Hilibrand AS, Carlson GC, Palumbo MA. Radiculopathy and myelopathy at segments adjacent to the site of a previous anterior cervical arthrodesis. J Bone Joint Surg. 1999;81A:519–528
  72. Emery S, Smith M, Bohlman H. Upper airway obstruction after multilevel cervical corpectomy for myelopathy. J Bone Joint Surg. 1991;73A(4):544–551
  73. Riew KD, Won DS, Calvert G, et al. Parameters for maintaining intubation postoperatively following anterior cervical procedures. North American Spine Society; 2001; Seattle, WA.
  74. Yone K, Matsunaga S. Posterior procedures for myelopathy (indications, techniques and results). Sem Spine Surg. 1999;11:331–336
  75. Kumar VG, Rea GL, Mervis LJ, McGregor JM, et al.  Cervical spondylotic myelopathy (functional and radiographic long-term outcome after laminectomy and posterior fusion). Neurosurgery. 1999;44:771–777
  76. Miyazaki K, Hirohuji E, Ono S. Extensive simultaneous multi-segmental laminectomy and posterior decompression with posterolateral fusion. J Jpn Res Soc. 1994;5:167
  77. Maurer PK, Ellenbogen RG, Eckland J, et al.  Cervical spondylotic myelopathy (treatment with posterior decompresson and Luque rectangle bone fusion). Neurosurgery. 1991;28:680–683
  78. Yonenobu H, Hosono N, Iwasaki M, et al.  Laminoplasty versus subtotal corpectomy (a comparative study of results in multisegmental cervical spondylotic myelopathy). Spine. 1992;17:1281–1284
  79. Satomi K, et al.  Long-term follow-up studies of open-door expansive laminoplasty for cervical stenotic myelopathy. Spine. 1994;19:507–510
  80. Tomita K, et al.  Expansive midline T-saw laminoplasty (modified spinous process splitting) for the management of cervical myelopathy. Spine. 1998;23:32–37
  81. Edwards C, Heller J. Posterior approaches for the surgical treatment for multilevel cervical spondylotic myelopathy (laminoplasty versus laminectomy). Curr Opin Orthop. 2001;12:224–230
  82. Kaptain GJ, Simmons NE, Replogle RE, Pobereskin L, et al.  Incidence and outcome of kyphotic deformity following laminectomy for cervical spondylotic myelopathy. J Neurosurg. 2000;93:1999–2004
  83. Mikawa Y, Shikata J, Yamamuro T. Spinal deformity and instability after multilevel cervical laminectomy. Spine. 1987;12(1):6–11
  84. Morimoto T, Okuno S, Nakasi H, et al.  Cervical myelopathy due to dynamic compression by the laminectomy membrane (dynamic MR imaging study). J Spinal Disord. 1999;12:172–173
  85. Snow RB, Weiner H. Cervical laminectomy and foraminotomy as surgical treatment of cervical spondylosis (a follow-up study with analysis of failures). J Spinal Disord. 1993;6:245–250
  86. Matsunaga S, Sakou T, Nakansisi K. Analysis of the cervical spine alignment following laminoplasty and laminectomy. Spinal Cord. 1999;37:20–24
  87. Raynor RB, Pugh J, Shapiro I. Cervical facetectomy and its effect on spine strength. J Neurosurg. 1995;63:278–282
  88. Nowinski GP, Visarius H, Nolte LP, Herkowitz HN, et al.  A biomechanical comparison of cervical laminoplasty and cervical laminectomy with progressive facetectomy. Spine. 1993;18:1995–2004
  89. Epstein NE. Laminectomy with posterior wiring and fusion for cervical ossification of the posterior longitudinal ligament, spondylosis, ossification of the yellow ligament, stenosis, and instability (a study of 5 patients). J Spinal Dis. 1999;12:461–466
  90. Heller JG, et al.  Laminoplasty versus laminectomy and fusion for the management of cervical myelopathy (an independent matched cohort analysis). Spine. 2001;26:1330–1336
  91. Wellman BJ, Follett KA, Traynelis VC. Complications of posterior articular mass plate fixation of the subaxial cervical spine in 43 consecutive patients. Spine. 1998;23:193–200
  92. Oyama M, Hattori S, Moriwaki N. A new method of posterior decompression. Chubuseisaisi. 1973;16:792; [in Japanese]
  93. Kurokawa T, Tsuyama N, Tanaka H. Enlargement of spinal canal by the sagittal splitting of the spinous process. Bessatsu Seikei Geka. 1982;2:234–240
  94. Hirabayashi K. Expansive open-door laminoplasty for cervical spondylotic myelopathy. Jpn J Surg. 1978;32:1159–1163 [in Japanese]
  95. Edwards CC, Heller JG, Silcox DH. “T-saw” laminoplasty for the management of cervical spondylotic myelopathy (clinical and radiographic outcome). Spine. 2000;25:1788–1794
  96. Tanaka J, Seki N, Tokimura F, et al.  Operative results of canal-expansive laminoplasty for cervical spondylotic myelopathy in elderly patients. Spine. 1999;24:2308–2312
  97. Kawaguchi Y, et al.  Surgical outcome of cervical expansive laminoplasty in patients with diabetes mellitus. Spine. 2000;25:551–555
  98. Matsumoto Y, et al.  Stability and alignment of the cervical spine of hemodialyzed patients treated by canal-expansive laminoplasty. Arch Orthop Trauma Surg. 1999;119:464–466
  99. Aita I, et al.  Posterior movement and enlargement of the spinal cord after cervical laminoplasty. J Bone Joint Surg. 1998;80B:33–37
  100. Baba H, et al.  Three-dimensional computed tomography for evaluation of cervical spinal canal enlargement after en block open-door laminoplasty. Spinal Cord. 1997;35:674–679
  101. Baba H, Uchida K, Maezawa Y. Lordotic alignment and posterior migration of the spinal cord following en bloc open door laminoplasty for cervical myelopathy (a magnetic resonance imaging study). J Neurol. 1996;243:626–632
  102. Lee TT, Manzano GR, Green BA. Modified open-door cervical expansive laminoplasty for spondylotic myelopathy (operative technique, outcome and predictors of gait improvement). J Neurosurg. 1997;86:64–68
  103. Kirita Y. Posterior decompression or the cervical spondylosis and ossification of the posterior longitudinal ligament in the cervical spine. Surgery. 1976;30:287–302 [in Japanese]
  104. Dai L, et al.  Radiculopathy after laminectomy for cervical compression myelopathy. J Bone Joint Surg. 1998;80B:846–849
  105. Yonenobu K, Yamamoto T, Ono K. Laminoplasty for myelopathy: indications, results, outcome and complications. In: Clark, editor. The cervical spine, 3rd ed. Philadelphia: 1998:849–864.
  106. Yonenobu K, et al.  Neurologic complications of surgery for cervical compression myelopathy. Spine. 1991;13(1277–1282):849–864
  107. Dante SJ, Heary R, Kramer D. Cervical laminectomy for myelopathy. Oper Tech Orthop. 1996;6:30–37
  108. Yonenobu K, et al.  Choice of surgical treatment for multisegmental cervical spondylotic myelopathy. Spine. 1985;10:710–716
  109. Yasuoka S, Peterson HA, MacCarty CS. Incidence of spinal column deformity after multilevel laminectomy in children and adults. J Neurosurg. 1982;57(4):441–445
  110. Blair J, Garfin SR. Complications of cervical laminectomy in degenerative disorders of the cervical spine. Sem Spine Surg. 1995;7:52–56
  111. Sasai K, Saito T, Akagi S. Cervical curvature after laminoplasty for spondylotic myelopathy—involvement of yellow ligament, semispinalis cervicis muscle, and nuchal ligament. J Spinal Disord. 2000;13:26–30
  112. Hosono N, Yonenobu K, Ono K. Neck and shoulder pain after laminoplasty (a noticeable complication). Spine. 1996;21:1969–1973
  113. Asano S, Nohara Y, Kiya T, Takemoto T. Postoperative management without immobilization of the cervical spine in patients undergoing cervical laminoplasty: effects on clinical and radiological outcomes. Cervical Spine Research Society; December 16–18, 1999; Seattle, WA.
  114. Baisden J, Voo LM, Cusick JF, et al.  Evaluation of cervical laminectomy and laminoplasty (a longitudinal study in the goat model). Spine. 1999;25:1288–1289
  115. Fields MJ, Hosjijima K, Feng AH, et al.  A biomechanical, radiologic and clinical comparison of outcome after multilevel cervical laminectomy or laminoplasty in the rabbit. Spine. 2000;25:1925–1931
  116. Edwards C, Heller J, Morikami H. Corpectomy versus laminoplasty for multi-level cervical myelopathy (an independent matched cohort study). Spine. 2002;in press:
  117. Wada E, Suzuki S, Kanazawa A. Subtotal corpectomy versus laminoplasty for multilevel cervical spondylotic myelopathy (a long-term follow-up study of over 10 years). Spine. 2001;26:1443–1447

☆ This Contemporary Concepts review article has been reviewed by the Board of the North American Spine Society (NASS). As such, it represents the current position of the state of knowledge of the above subject in spine care. This series is edited by Alexander Vaccaro, MD. Prior to entering the review process for The Spine Journal, the authors were assisted by members of the NASS Committee on Contemporary Concepts, Alexander Vaccaro, MD, Chair.

☆☆ FDA device/drug status: not applicable.

★ Nothing of value received from a commercial entity related to this research.

PII: S1529-9430(02)00566-1

The Spine Journal
Volume 3, Issue 1 , Pages 68-81 , January 2003

Article Tools

* Image Usage & Resolution