The spine consists of a series of vertebra that are stacked on top of another from the neck to the pelvis. These vertebraes are connected and kept in correct position by the discs that are between the vertebra and also the facet joints that are located on the side of the vertebral bodies and these interlock with each other.
There are also supporting ligaments and tendons. The discs between the two adjacent vertebraes are composed of a central, soft, jelly-like substance called the nucleus pulposus and an outer, tougher fibrous part called the annulus fibrosus.

What happens in some people is that the tough annulus fibrosus becomes damaged and tears, leaving a defect in the strong outer layer. A bit of the nucleus pulposus can then push through this tear and end up in the spinal canal and press against the nerves in the spinal canal. This can be because of a traumatic injury but is usually due to an inborn predisposition towards weak discs.

At the same time the facet joints at the back of the neck can undergo osteoarthritic changes. The combination of loss of height and facet joint arthritis leads to an imbalance of the neck. At the same time the artrhitic changes in the joints and malalignment of the spine causes local nerve and muscle irritation which leads to muscle spasm and referred pain.


What is it?

Cervical osteoarthritis and malalignment is called cervical spondylosis. When the spinal canal is narrowed and the spinal cord is being compressed, it leads to dysfunction of the nerves of the spinal cord.

What are the symptoms?

This dysfunction is called myelopathy. Myelopathy is a disease of the spinal cord that manifests as pain and weakness in the arms and also spasticity of the arms. It can also cause spasticity of the legs and even dysfunction of the nerves to the bladder and the bowel.

How is it diagnosed?

A clinical examination by your doctor or therapist will allow for a reasonable suspicion but the only definite way is by doing a magnetic resonance (MR) scan (see the section on tests).
Sometimes because of technical factors a CT scan is performed (see the section about tests). This is usually when a MR scan cannot be performed due to the unavailability of a MR scanner, when there are contra indications to doing a scan or there are technical factors like the presence of metal fusion apparatus in the spine that make a MR scan unreliable.
See the section on tests for the terminology that you will find on your MR scan report and what it means in plain English. Sometimes EMG’s are also used (see the section on tests).

What is the treatment?

The only successful treatment for cervical spondylotic myelopathy is surgery. The treatment consists of decompressing the spinal cord and the nerves that arise from the spinal cord.

The operation can be from the front of the spine and these operations are called discectomies and corpectomies and are usually accompanied by an intervertebral fusion. Sometimes the operation is done from the back and these operations are called laminectomies or laminoplasties and they may sometimes be accompanied by a posterior spinal fusion. A fusion is performed if the surgery to decompress the nerves is so extensive that it makes the spine unstable. Please see the sections on the different operations for an explanation and description of these techniques.