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Cervical spondylotic myelopathy. A diagnostic challenge in aging patients.

Cervical spondylotic myelopathy remains a diagnostic and therapeutic challenge to physicians in a number of specialties. The diagnostic evaluation consists of a comprehensive neurologic and orthopedic examination supplemented by appropriate neurophysiologic and neuroradiologic studies. Currently, magnetic resonance imaging and myelography with computed tomography are the imaging methods of choice. Conservative therapy helps one half of patients with cervical spondylotic myelopathy, and surgery may benefit up to three quarters. Although this condition is entirely benign pathologically, its clinical manifestations appear malicious and deleterious. As new diagnostic and therapeutic techniques are refined, management of the disease should become even more successful.