This 2001 narrative review by Emery covers the full scope of cervical spondylotic myelopathy—pathoanatomy, natural history, clinical presentation, radiologic workup, surgical indications, and approach selection—providing a decision-making framework for residents encountering this diagnosis.
When you see a patient with subtle gait changes, hand clumsiness, or hyperreflexia — even without prominent neck pain.
Perform the finger-escape and grip-and-release tests and get an MRI: ~15% of moderate-to-severe CSM patients have no neck pain, and a preoperative cord area below 30 mm² on CT-myelography signals that neurologic recovery will be limited regardless of approach.
If the cervical spine is kyphotic, plan an anterior approach. Posterior decompression cannot adequately relieve anterior cord compression in the absence of lordosis.
This 2001 narrative review by Emery covers the full scope of cervical spondylotic myelopathy—pathoanatomy, natural history, clinical presentation, radiologic workup, surgical indications, and approach selection—providing a decision-making framework for residents encountering this diagnosis.
When you see a patient with subtle gait changes, hand clumsiness, or hyperreflexia — even without prominent neck pain.
Perform the finger-escape and grip-and-release tests and get an MRI: ~15% of moderate-to-severe CSM patients have no neck pain, and a preoperative cord area below 30 mm² on CT-myelography signals that neurologic recovery will be limited regardless of approach.
If the cervical spine is kyphotic, plan an anterior approach. Posterior decompression cannot adequately relieve anterior cord compression in the absence of lordosis.