CERVICAL SPONDYLOTIC MYELOPATHY. ITS CLINICAL MANIFESTATIONS AND SPINAL CORD PATHOLOGY
Journal Title: Journal of Turkish Spinal Surgery - Year 2003, Vol 14, Issue 1
Abstract
Cervical spondylosis is one of the most common disorders that all people over middle age. Problems brought by this condition have become more serious to societies where aged population is expending. Clinical manifestations of cervical spondylosis are quite diverse and schematically these can be classified into discopathy, radiculopathy, myelopathy and miscellaneous conditions. Among them, myelopathy is relatively rare but disability of myelopathic patients is more severe and permanent. Clinical features of cervical spondylotic myelopathy (CSM) are composition of symptoms of segmental and long tract impairment. Segmental symptoms are ambiguous to radicular symptoms and thus the symptoms are sometimes regarded as radicular origin, and diagnosed to be radiculomyelopathy erroneously. In Japan we have many patients with CSM, probably due to developmental spinal canal size. Experientially, most of patients with CSM have only combination of long tract and segmental signs, and the diagnosis of CSM is easy by neurological and radiological examinations. On the other hand, we have experienced patients having muscular weakness and atrophy of the upper extremity without obvious sensory deficit of the upper extremity, that is vague to lower motor neuron diseases(2-3). Sobue named this condition cervical spondylotic amyotrophy (CSA). Anyway, both conditions are myelopathic. What changes of the spinal cord occur in these conditions? Since Key described encroachments on the spinal cord by ventral ridges of disc origin in 1838, the condition has been studied from various viewpoints. Although several pathological studies on the spinal cord were done, little was known about relationship between clinical manifestations and spinal cord pathology of CSM. We carried out a clinicopathological study to elucidate the relationship(2). We found that severity of pathological changes was paralleled to severity of myelopathic symptoms, and the severity of pathological changes could be represented with a simple morphometric parameter, compression ration (=anteroposterior diameter of the spinal cord divided by transverse diameter).
Authors and Affiliations
Kazuo Yonenobu, M. D. , D. M. Sc.
Keywords
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