The spinal column is made up of small bones (vertebrae) stacked on top of one another, creating the natural curves of the back. Between the vertebrae are flat, round, rubbery pads (intervertebral disks) that act as shock absorbers and allow the back to flex or bend. Muscles and ligaments connecting the vertebrae allow motion while providing support and stability for the spine and upper body. Each vertebra has an opening (foramen) in the center and these line up to form the spinal canal. Protected by the vertebrae, the spinal cord and other nerve roots travel through the spinal canal. Nerves branch out from the spinal column through vertebral openings, carrying messages between the brain and muscles. Facet joints align at the back of the spinal column, linking the vertebrae together and allowing for rotation and movement. Like all joints, cartilage covers the surface where facet joints meet.
The spine contains three segments: lumbar, thoracic and cervical. The lumbar spine consists of five vertebrae located in the lower back; lumbar vertebrae are larger because they carry more of the body's weight. The thoracic spine consists of 12 vertebrae and begins at the upper chest, extending to the middle back and connecting to the rib cage. The cervical spine includes the neck and consists of seven small vertebrae, beginning at the base of the skull and ending at the upper chest. Disks in the lumbar spine are composed of a thick outer ring of cartilage (annulus) and an inner gel-like substance (nucleus). In the cervical spine, disks are similar but smaller in size. The cervical spine supports the weight of the head and connects it to the shoulders and body. It is less protected than the rest of the spine, making it more vulnerable to injury and disorders that produce pain and restricted motion.
Cervical spondylotic myelopathy (CSM) is one of the most common age-related neck conditions in the United States. Over time, normal wear-and-tear and effects of aging can lead to a narrowing of the spinal canal (spinal stenosis), compressing, or squeezing, the spinal cord. Symptoms usually begin after age 50, but can occur earlier if the patient suffered an injury to the spine at a younger age. Once symptoms of CSM begin, they tend to continue. Typically, patients with CSM experience slow, steady progression of their disease, over several years. In approximately 5% to 20% of patients, CSM worsens more rapidly.
Neck pain may result from abnormalities in the soft tissues (muscles, ligaments, and nerves) as well as in bones and joints of the spine. The most common causes of neck pain are soft-tissue abnormalities due to injury or prolonged wear-and-tear. In rare instances, infection or tumors may cause neck pain. In some people, neck problems may be the source of pain in the upper back, shoulders, or arms.
CSM can cause a variety of symptoms, including: a tingling, prickling or "pins and needles" sensation (paresthesia); numbness; weakness, difficulty lifting objects, or frequent dropping of objects; difficulty walking (loss of balance), wide-based gait; coordination problems, clumsiness, difficulty with simple tasks such as handwriting, buttoning clothes or feeding oneself; neck pain and stiffness.
To fully assess your condition and confirm your diagnosis, additional imaging studies may be required, such as: X-rays; magnetic resonance images (MRI); or myelogram, a special type of computed tomography (CT). After discussing your medical history and symptoms with you, your physician will examine your neck and look for:
Some patients obtain relief from symptoms with nonsurgical treatment options.
Whether or not surgery is appropriate for you is a complex decision you must make with your physician, taking into consider a variety of factors, including your overall health. The surgical goal for CSM is to open the space for the spinal cord, or "decompress" the spinal canal, by removing parts of bone or soft tissue, or both. There are a variety of successful surgical techniques for treating CSM, and decompression is performed either from the front (anterior) of the neck, or the back (posterior). Each approach has advantages and disadvantages, and neither is ideal for every patient.
It is typical to spend 1 or 2 days in the hospital following surgery, and to begin walking and eating on the first day. However, recovery and rehabilitation vary for each person and your specific experience will depend on how many disk levels were involved and how you respond to the procedure. It is normal to have difficulty swallowing solid foods for a few weeks, or to experience some hoarseness following anterior cervical surgery. You may need to wear a soft or rigid collar at first. How long will depend on the type of surgery you had. Your surgeon will likely encourage you to begin walking as soon as possible.
As with any surgery, there are some risks, and these vary from person to person. These are typically minor, treatable and unlikely to affect your final outcome. For most people, surgery can provide relief of symptoms and return to function with relatively low risk of complications. Discuss the potential risks and benefits specific to each technique with your surgeon prior to surgery.
In general, elderly patients have higher rates of complications from surgery, as do patients who are overweight, diabetics, smokers, or suffering from multiple medical problems. General, potential risks for cervical spine surgery include: infection, bleeding, injury to nerves or spinal cord, reactions to anesthesia, tearing of the sac covering the nerves (dural tear), need for additional surgery in the future, and failure to relieve symptoms.
The primary goal of surgery for CSM, regardless of approach, is to stabilize the spine and prevent worsening of neurologic problems, but not necessarily to restore normal function. A secondary goal is potentially improving associated neck pain, motor (weakness), sensory (numbness/tingling), and gait (walking) disturbances. Although final outcomes vary by patient, compared to pre-surgical symptoms: one-third typically improve, one-third typically remain unchanged, and one-third continue to worsen over time. Patients with CSM are recommended for surgery to make sure that their symptoms do not worsen—in most cases, the symptoms they have going into the operating room are the same symptoms they will experience afterwards. Your surgeon will discuss this with you and provide information on what the likelihood of improvement is in your individual situation.
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