neurologic disorders
Cervical Spondylosis and Spondylotic Cervical Myelopathy
Key Points
Cervical spondylosis due to osteoarthritis, especially if the cervical canal is congenitally narrow, can lead to stenosis of the canal and development of osteophytes, which may compress the cord or nerve roots. Cord compression commonly causes gradual spastic paresis and/or paresthesias in the hands and feet and may cause hyperreflexia, eventually resulting in muscle atrophy, with flaccid paresis in the upper extremities at the level of the compression, and spasticity below that level. Nerve root compression commonly causes early radicular pain, sometimes followed by weakness, hyporeflexia, and muscle atrophy. Diagnose using MRI or CT. If the spinal cord is severely compressed, do a cervical laminectomy, usually with an anterior approach; for radiculopathy alone, try NSAIDs plus a soft cervical collar, but if this treatment is ineffective, consider surgical decompression. 