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Cervical spondylosis and spondylotic cervical myelopathy
Last reviewed: 04.07.2025
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Cervical spondylosis is an osteoarthritis of the cervical vertebrae causing spinal stenosis and sometimes cervical myelopathy due to the impact of bony osteoarthritic growths (osteophytes) on the lower cervical segments of the spinal cord, sometimes involving adjacent cervical roots (radiculomyelopathy).
Cervical spondylosis due to osteoarthritis is quite common. Less commonly, particularly in cases of congenital narrowness of the spinal canal (less than 10 mm), it can lead to stenosis and impact of bone growths on the spinal cord, causing myelopathy. Osteophytes in the area of the intervertebral foramina, most often between C5 and C6 or C6 and C7 vertebrae, can cause radiculopathy. The clinical manifestation is determined by the neural structures involved.
Spinal cord compression usually causes gradually increasing spastic paresis, paresthesias in both arms and legs, and reflexes may be increased. Neurological deficits may be asymmetrical, non-segmental, and worsen with coughing or the Valsalva maneuver. Ultimately, muscle atrophy and flaccid paresis of the upper extremities may develop according to the level of the lesion, with spastic paresis below the level of the lesion.
Compression of the roots often causes radicular pain in the early stages, with weakness, decreased reflexes and muscle atrophy later joining in.
Cervical spondylosis may be suspected in the presence of characteristic neurological deficits in elderly patients with osteoarthritis or radicular pain at the C5 or C6 level. MRI or CT is mandatory to clarify the diagnosis. If there is evidence of spinal cord involvement, cervical laminectomy is usually necessary. A posterior approach can reduce the degree of compression, but anterior osteophytes remain, and spinal instability and kyphosis may develop, so an anterior approach with vertebral fusion is increasingly used. In the presence of radiculopathy alone, conservative treatment is necessary with NSAIDs (eg, diclofenac, lornoxicam) and aluvants (tizanidine), a soft cervical collar. If this treatment is ineffective, surgical decompression may be considered.
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