Cervical Spondylotic Myelopathy

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Condition: Cervical spondylotic myelopathy (CSM) is a condition where the spinal cord is damaged or pinched, either due to an injury, abnormal movements, or as a part of aging.

Background: In the U.S., CSM is the most common cause of spinal cord dysfunction in people over 55. As a person ages, the bones and cartilage of the backbone and neck begin to deteriorate (develop arthritis). For instance, spinal disks can develop cracks or lose their ability to cushion the vertebrae. This deterioration can cause damage to the spinal cord.

Risk Factors: Although the primary risk factor is aging, others who are at greater risk for CSM are people who have had neck injuries previously, as well as smokers and people with jobs that require them to use their neck repetitively or awkwardly. Men are also at greater risk.

History and Symptoms: Loss of balance is usually the first symptom a patient notices. Examples of other symptoms are arm and leg spasms, pain in the arms and legs, numbness, weakness and less dexterity in the hands and legs. Symptoms that require urgent assessment include sudden loss of the ability to walk, or loss of bowel and bladder control.

Physical Exam:  A physical medicine and rehabilitation (PM&R) physician, also known as a physiatrist, will likely ask the patient to move his or her neck into various positions, have the patient walk and test his or her muscle strength, sensation and reflexes.

Diagnostic Process: To accurately diagnose CSM, a PM&R physician may order an MRI or CT scan, or perform an electromyogram (EMG), a test to check the function of the muscles and nerves.

Rehab Management: Rehabilitation depends on the extent of the damage and the patient’s symptoms. For example, patients may benefit from physical therapy; in addition, others may need occupational therapy to improve their hand function. Fall prevention is very important for CSM patients; they should be advised to use assistive devices such as canes or walkers as needed, determined by a PM&R physicians. PM&R physicians are uniquely qualified to manage the pain, muscle spasms, and functional implications of this disorder.

Other Resources for Patients and Families: The NIH has additional resources that can help patients and families.


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