Posts Tagged ‘bilateral facet degeneration and uncovertebral hypertrophic change lateral osteophyte.’
Cervical Spondylotic Myelopathy Requires Prompt Surgery
With widely varying signs and symptoms and no single pathognomonic finding, cervical spondylotic myelopathy presents a diagnostic challenge. Yet making the correct diagnosis is critical because appropriate surgical intervention is associated with improved outcomes…
Both static and dynamic mechanisms are involved in the pathogenesis of cervical spondylotic myelopathy. Static factors include congenital spinal canal stenosis (<13 mm anterior-posterior diameter); disc herniation; osteophyte formation in the vertebral bodies; degenerative osteophytosis of uncovertebral and facet joints; hypertrophy ligamentum flavum posterior longitudinal ligaments…
The onset of cervical spondylotic myelopathy is generally insidious, with long periods of fixed disability and episodic worsening. In one series, symptom duration ranged from one week to 26 years. Almost half of patients presented with symptoms of more than one year in duration.
Other symptoms : -
Pain in the neck, subscapular area or shoulder. Numbness or paresthesia in the upper extremities, usually nonspecific. Sensory changes in the lower extremities. Motor weakness in the extremities. Gait difficulties (“spastic gait,” hesitant and jerky).
The differential diagnosis of cervical spondylotic myelopathy is quite broad. It is important to rule out multiple sclerosis and amyotrophic lateral sclerosis. Cervical spondylotic myelopathy does not affect the cranial nerves or the normal jaw jerk reflex, whereas the other disorders may. In addition, amyotrophic lateral sclerosis is a pure motor disease, therefore, sensation is unaffected…
The diagnostic workup of cervical spondylotic myelopathy often includes cervical radiographs, which may demonstrate osteophyte formation, kyphosis or subluxation. The most valuable tool, however, is MRI. Along with the ability to rule out a tumor or syrinx (a slit-like cavity in the spinal cord), MRI permits specific evaluation of the spinal cord, intervertebral discs, vertebral osteophytes and ligaments…
Cervical spondylotic myelopathy patients treated medically (i.e., with collar immobilization and traction) show continual progressive neurologic deterioration. One series of 1,355 patients treated conservatively revealed no improvement in 64 percent and neurological deterioration in 26 percent…
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