What is the natural history of cervical spondylotic myelopathy?

Updated: Nov 09, 2018
  • Author: Sandeep S Rana, MD; Chief Editor: Tarakad S Ramachandran, MBBS, MBA, MPH, FAAN, FACP, FAHA, FRCP, FRCPC, FRS, LRCP, MRCP, MRCS  more...
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Answer

The natural history of cervical spondylotic myelopathy is highly variable. The older literature notes the natural course of cervical spondylotic myelopathy to be that of progressive disability and deterioration in neurologic function. Nurick, however, noted that a period of initial deterioration occurs, followed by a clinical plateau that lasts for several years, during which disability does not worsen for those with mild cervical spondylotic myelopathy. He noted that older patients deteriorate more frequently and, thus, advocates surgery for those older than 60 years and for those with progressive decline in neurologic function. [38]

Another factor that must be taken into consideration is that patients with cervical spondylotic myelopathy may be at risk for significant spinal cord injury, even with minor trauma. This argument, in addition to improved surgical outcomes in those with decreased duration of symptoms, has been used as an argument supporting surgery.

Nevertheless, a Cochrane review found the natural course of cervical spondylotic myelopathy to be highly variable for patients with mild-to-moderate symptoms, in whom the review noted the disease to often remain static and symptoms to occasionally improve. [39] Similarly, for mild-to-moderate cervical spondylotic myelopathy, a 3-year prospective randomized trial found no significant difference between patients who were treated surgically and those who were treated conservatively. [40]


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