This 2015 narrative review from JAAOS covers the diagnosis and surgical management of cervical spondylotic myelopathy (CSM), the most common cause of spinal cord impairment in adults. It addresses clinical presentation, imaging evaluation, outcome measures, surgical approach selection, intraoperative considerations, and complications, drawing on large prospective multicenter data.
When evaluating a CSM patient for surgery, assess sagittal alignment first — kyphosis >13° or a positive modified K-line finding means a posterior-only approach is likely to fail, and an anterior or combined strategy is needed.
Intraoperatively, MEPs are your most sensitive and specific neuromonitoring tool (100% sensitivity and NPV) for catching impending cord injury before it becomes permanent.
This 2015 narrative review from JAAOS covers the diagnosis and surgical management of cervical spondylotic myelopathy (CSM), the most common cause of spinal cord impairment in adults. It addresses clinical presentation, imaging evaluation, outcome measures, surgical approach selection, intraoperative considerations, and complications, drawing on large prospective multicenter data.
When evaluating a CSM patient for surgery, assess sagittal alignment first — kyphosis >13° or a positive modified K-line finding means a posterior-only approach is likely to fail, and an anterior or combined strategy is needed.
Intraoperatively, MEPs are your most sensitive and specific neuromonitoring tool (100% sensitivity and NPV) for catching impending cord injury before it becomes permanent.