Turkish Journal of Physical Medicine and Rehabilitation 2006 , Vol 52 , Num 1

Cervical Spondylotic Myelopathy

Nilay Şahin 1 ,Ender Berker 2
1 Department of Physical Medicine and Rehabilitation, Balıkesir Univesity Faculty of Medicine, Balıkesir, Turkey
2 İstanbul Üniversitesi İstanbul Tıp Fakültesi Fiziksel Tıp ve Rehabilitasyon Anabilim Dalı, İstanbul, Türkiye

Cervical spondylotic myelopathy is the most serious complication of cervical spondylosis and has an insidious onset at the fifth to sixth decades of life. The initial symptoms are deep aching and burning sensation, loss of fine motor control and muscular strength of the upper extremities, dysesthesias, difficulty in writing and walking as well as balance impairments. Early symptoms may mimic radicular/nerve root involvement leading to misdiagnosis. Physical examination demonstrates lower motor neuron symptoms at the lesion level and upper motor neuron symptoms below the level of the lesion. Pathological reflexes as well as L'Hermitte and Spurling signs may also be present. Lateral cervical roentgenograms and imaging studies, intrathecal contrast computerized tomography, myelo-computerized tomography and magnetic resonance imaging are the main tools for diagnosis. Lateral X-rays are helpful in measuring Torg and Pavlov ratio where the decrease to 0.8-0.7 may point out premyelopathy. Electromyography, somatosensory evoked potentials and motor evoked potentials as well as urodynamic investigations are also used in the diagnosis. In most studies it was concluded that conservative treatment had lower efficacy, however, intensive treatment following a comprehensive physical examination lead to better results. Cervical traction, cervical immobilization and other physical therapy agents may be used in conservative therapy, but there is limited evidence for this hypothesis. The researchers declared that during the first 18 months after diagnosis of surgical treatment may demonstrate positive outcome.

Keywords : Cervical spondylosis, cervical disc degeneration, cervical myelopathy