Cervical spondylotic myelopathy - the "king" of cervical spondylotic diseases, seek medical attention as soon as possible

This is the 5239th article of Da Yi Xiao Hu

The so-called cervical spondylotic myelopathy refers to a syndrome in which a series of symptoms occur due to compression of the spinal cord or the blood vessels supplying the spinal cord by degenerative structures of the cervical spine (intervertebral discs, osteophytes, ossified ligaments, etc.), including sensory, motor, reflex, and bowel and urinary dysfunction in the limbs. The incidence rate accounts for 10%-15% of cervical spondylotic myelopathy, and it is the most serious type of cervical spondylotic myelopathy. The early symptoms are relatively hidden, and patients often do not have special discomfort such as limb pain, which is not easily taken seriously by patients and their families. Once a patient is diagnosed with cervical spondylotic myelopathy, the doctor will recommend surgical treatment as soon as possible. Why is this? The main reasons are as follows:

First of all, if cervical spondylotic myelopathy is not treated in time, serious consequences that are difficult to recover will occur. Due to continuous compression of the spinal cord, patients with cervical spondylotic myelopathy will experience symptoms such as weakness in the lower limbs, trembling, weak legs, easy stumbling, paresthesia and numbness in both lower limbs; numbness, soreness, burning, pain, trembling or weakness in the upper limbs may also occur, and the patient may not be able to eat with chopsticks, tremble when writing, and have difficulty holding things with the hands. As the disease progresses, the spinal cord is severely compressed, and even serious symptoms such as quadriplegia, urinary retention, and constipation may occur. If the spinal cord nerves are compressed for too long and are in a state of hypoxia due to insufficient blood supply for a long time, spinal cord degeneration and nerve cell apoptosis will occur. At the current medical level, there is a lack of effective treatment for such severe spinal cord nerve damage. Surgery at this time can only prevent the disease from further aggravating. It is very difficult to restore normal nerve function, and it may leave obvious sequelae.

Secondly, there is currently a lack of effective conservative treatments for cervical spondylotic myelopathy. Since the cause of cervical spondylotic myelopathy is continuous compression of the spinal cord, no medication or other conservative treatments can relieve this compression and cannot fundamentally eliminate the cause. Traction and massage, which are commonly used to treat cervical spondylotic myelopathy, are not suitable for cervical spondylotic myelopathy and may even aggravate the symptoms. Currently, only surgery can completely relieve the compression of the spinal cord and restore the nutrient blood supply to the spinal cord.

Therefore, in view of the pathological characteristics of cervical spondylotic myelopathy, non-surgical treatment cannot relieve spinal cord compression, and the chances of reversal and self-limitation are slim. Especially when MRI examination reveals localized abnormal high signals in the spinal cord, the patient has walking and balance disorders, hand coordination disorders, or progressively worsening neurological dysfunction, if there are no contraindications to surgery, surgical treatment should be performed as soon as possible.

The red arrow points to the localized abnormal high signal of the spinal cord, indicating spinal cord damage; the blue arrow points to the huge cervical disc herniation that compresses the spinal cord

Unit: Department of Orthopedics, Zhongshan Hospital Affiliated to Fudan University

Institute of Medical Science Popularization, Fudan University

Author: Li Juan, Lin Hong

Instructor: Dong Jian

Shanghai Science and Technology Commission Science and Technology Innovation Action Plan Science Popularization Project 23DZ2300500, 24DZ2305800, Shanghai Health Science Popularization Talent Capacity Improvement Project (Leading Talent) KKPYL-2023-B04