11/28/2023 0 Comments Myelopathic![]() ![]() During neck flexion, the spinal cord stretches and can be compressed against osteophytic spurs and intervertebral discs protruding into the canal.Ossification, hypertrophy or laxity of ligamentum flavum 2.Hypertrophy of facet capsules and laxity of facet joints 1.Osteophytes can project from the uncovertebral and facet joints.Reactive hypertrophy occurs and osteophytes form at the vertebral end plates. ![]() Decreased height of desiccated intervertebral discs leads to increased sagittal diameter and disc bulging. ![]() Disc degeneration is typically the initiating factor for CSM.Both static and dynamic factors contribute to myelopathy.Stenosis is relative if the diameter is 10-13 mm. Absolute spinal canal stenosis exists with a sagittal diameter below 10 mm. The space required by the spinal cord averages 10 mm. The average anterior-posterior (AP) diameter of the canal measures about 17 mm from C3-C7.Patients over age 60 often have multi-segmental disease, with C5 and C6 being the most frequent levels at which compression occurs.The more mobile mid-cervical segments, C5 to C7, are most frequently involved.Men are affected more than women (2.7:1).CSM is the most common cause of spinal cord dysfunction in adults over age 55.8Įpidemiology including risk factors and primary prevention Surgical fusion of cervical vertebrae can lead to increased spondylosis in adjacent segments.Congenital anomalies of the cervical spine such as Klippel-Feil syndrome can lead to accelerated spondylosis.A congenitally narrow canal lowers the threshold by which trivial trauma or degenerative changes may cause myelopathy.It usually develops insidiously but may be precipitated by trauma. CSM results from degenerative changes in the cervical spine, including the vertebrae, uncovertebral and facet joints, intervertebral discs, ligaments (ligamentum flavum hypertrophy, posterior longitudinal ligament ossification) and connective tissue.CSM is a clinical diagnosis and presents with at least one neurological sign and at least one neurological symptom, in addition to a positive MRI for compression of the spinal cord.It can occur either directly by mechanical compression and abnormal movement, or indirectly by ischemia due to arterial compression or venous stasis. Cervical Spondylotic Myelopathy (CSM), also referred to as degenerative cervical myelopathy (DCM), is a progressive degenerative process of the cervical spine resulting in narrowing of the central spinal canal and compression of the spinal cord. ![]()
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