Current management of patients with degenerative cervical spine compres­sion

Authors: Z. Kadaňka Jr.;  T. Horák;  J. Bednařík
Authors‘ workplace: Neurologická klinika LF MU a FN Brno
Published in: Cesk Slov Neurol N 2019; 82(6): 632-636
Category: Review Article


Degenerative cervical myelopathy (DCM) is the most serious consequence of cervical spinal stenosis (CS) and degenerative cervical spinal cord compres­sion. The spinal cord, however, is quite resistant especially to gradual, chronic mechanical compres­sion. Asymptomatic degenerative cervical cord compression (ADCCC), which is characterized by cervical cord compression in medical imaging techniques, but without clinical signs of myelopathy, is therefore very common. In patients with moderate and severe DCM, surgical intervention is strongly recom­mended. However, in patients with mild DCM and ADCCC, there is no clear, evidence-based agreement on the management and treatment algorithm. Currently, a lot of predictors of ADCC progression to symptomatic DCM have been identified and this has led some surgeons to recommend early decompression surgery in these high-risk patients. However, further studies are required to refine our understanding of the importance of these predictors. Moreover, there are some methodological and ethical challenges that make multicentre randomized study in ADCCC and mild DCM patients difficult to realize.

The authors declare they have no potential conflicts of interest concerning drugs, products, or services used in the study.

The Editorial Board declares that the manu­script met the ICMJE “uniform requirements” for biomedical papers.


degenerative cervical myelopathy – asymptomatic degenerative cervical cord compression – spinal cervical stenosis


1. Montgomery DM, Brower RS. Cervical spondylotic myelopathy. Clinical syndrome and natural history. Orthop Clin North Am 1992; 23(3): 487– 493.

2. Teresi LM, Lufkin RB, Reicher MA et al. Asymp­tomatic degenerative disk dis­ease and spondylosis of the cervical spine: MR imaging. Radiology 1987; 164(1): 83– 88. doi: 10.1148/ radiology.164.1.3588931.

3. Kovalova I, Kerkovsky M, Kadanka Z et al. Prevalence and imag­­ing characteristics of nonmyelopathic and myelopathic spondylotic cervical cord compres­sion. Spine (Phila Pa 1976) 2016; 41(24): 1908– 1916. doi: 10.1097/ BRS.0000000000001842.

4. Adamova B, Bednarik J, Andrasinova T et al. Does lumbar spinal stenosis increase the risk of spondylotic cervical spinal cord compres­sion? Eur Spine J 2015; 24(12): 2946– 2953. doi: 10.1007/ s00586-015-4049-0.

5. Shamji MF, Ames CP, Smith JS et al. Myelopathy and spinal deformity: relevance of spinal alignment in plan­n­­ing surgical intervention for degenerative cervical mye­lopathy. Spine (phila Pa 1976) 2013; 38 (22 Suppl 1): S147– S148. doi: 10.1097/ BRS.0b013e3182a7f521.

6. Karadimas SK, Gatzounis G, Fehlings MG. Pathobio­logy of cervical spondylotic myelopathy. Eur Spine J 2015; 24 (Suppl 2): 132– 138. doi: 10.1007/ s00586-014-3264-4.

7. Tracy JA, Bartleson JD. Cervical spondylotic myelopathy. Neurologist 2010; 16(3): 176– 187. doi: 10.1097/  NRL.0b013e3181da3a29.

8. Kalsi-Ryan S, Karadimas SK, Fehlings MG. Cervical spondylotic myelopathy: the clinical phenomenon and the cur­rent pathobio­logy of an increasingly prevalent and devastat­­ing disorder. Neuroscientist 2013; 19(4): 409– 421. doi: 10.1177/ 1073858412467377.

9. Fehlings MG, Tetreault LA, Riew KD et al. A Clinical practice guideline for the management of patients with degenerative cervical myelopathy: recom­mendations for patients with mild, moderate, and severe dis­ease and nonmyelopathic patients with evidence of cord compres­sion. Global Spine J 2017; 7 (3 Suppl): 70S– 83S. doi: 10.1177/ 2192568217701914.

10. Benzel EC, Lancon J, Kesterson L et al. Cervical laminectomy and dentate ligament section for cervical spondylotic myelopathy. J Spinal Disord 1991; 4(3): 286– 295.

11. Vitzthum HE, Dalitz K. Analysis of five specific scores for cervical spondylogenic myelopathy. Eur Spine J 2007; 16(12): 2096– 2103. doi: 10.1007/ s00586-007-0512-x.

12. Clarke E, Robinson PK. Cervical myelopathy: a complication of cervical spondylosis. Brain 1956; 79(3): 483– 510. doi: 10.1093/ brain/ 79.3.483.

13. Kadaňka Z. Spondylogen­ní cervikální myelopatie. Cesk Slov Neurol N 2010; 73/ 106(3): 209– 226.

14. Wilson JR, Bar­ry S, Fischer DJ et al. Frequency, timing, and predictors of neurological dysfunction in the nonmyelopathic patient with cervical spinal cord compres­sion, canal stenosis, and/ or os­sification of the posterior longitudinal ligament. Spine (Phila Pa 1976) 2013; 38 (22 Suppl 1): S37– S54. doi: 10.1097/ BRS.0b013e3182a7f2e7.

15. Bednarik J, Kadanka Z, Dusek L et al. Presymp­tomatic spondylotic cervical myelopathy: an updated predictive model. Eur Spine J 2008; 17(3): 421– 431. doi: 10.1007/ s00586-008-0585-1.

16. Bednařík J, Sládková D, Kadaňka Z et al. Are subjects with spondylotic cervical cord encroachment at increased risk of cervical spinal cord injury after minor trauma? J Neurol Neurosurg Psychiatry 2011; 82(7): 779– 781. doi: 10.1136/ jn­np.2009.198945.

17. Keřkovský M, Bednařík J, Dušek L et al. Magnetic resonance dif­fusion tensor imag­­ing in patients with cervical spondylotic spinal cord compres­sion: cor­relations between clinical and electrophysiological findings. Spine (Phila Pa 1976) 2012; 37(1): 48– 56. doi: 10.1097/ BRS.0b013e31820e6c35.

18. Keřkovský M, Bednařík J, Jurová B et al. Spinal cord MR dif­fusion properties in patients with degenerative cervical cord compres­sion. J Neuroimag­­ing 2017; 27(1): 149– 157. doi: 10.1111/ jon.12372.

19. Kadanka Z, Adamova B, Kerkovsky M et al. Predictors of symp­tomatic myelopathy in degenerative cervical spinal cord compres­sion. Brain Behav 2017; 7(9): e00797. doi: 10.1002/ brb3.797.

20. Emery SE. Cervical spondylotic myelopathy: dia­g­nosis and treatment. J Am Acad Orthop Surg 2001; 9(6): 376– 388.

21. Shedid D, Benzel EC. Cervical spondylosis anato­-my: pathophysiology and bio­mechanics. Neurosurgery 2007; 60 (1 Suppl 1): S7– S13. doi: 10.1227/ 01.NEU.0000215430.86569.C4.

22. Epstein NE. Laminectomy for cervical myelopathy. Spinal Cord 2003; 41(6): 317– 327. doi: 10.1038/

23. Murphy DR, Coulis CM, Ger­rard JK. Cervical spondylosis with spinal cord encroachment: should preventive surgery be recom­mended? Chiropr Osteopat 2009; 17: 8. doi: 10.1186/ 1746-1340-17-8.

24. Gibson J, Nouri A, Krueger B et al. Degenerative cervical myelopathy: a clinical review. Yale J Biol Med 2018; 91(1): 43– 48.

25. Zhang RJ, Shen CL, Zhang JX et al. Clinical features and surgical outcomes of cervical spondylotic myelopa­thy in patients of dif­ferent ages: a retrospective study. Spinal Cord 2018; 56(1): 7– 13. doi: 10.1038/ sc.2017.91.

26. Tetreault L, Ibrahim A, Côté P et al. A systematic review of clinical and surgical predictors of complications fol­low­­ing surgery for degenerative cervical mye­lopathy. J Neurosurg Spine 2016; 24(1): 77– 99. doi: 10.3171/ 2015.3.SPINE14971.

Paediatric neurology Neurosurgery Neurology

Article was published in

Czech and Slovak Neurology and Neurosurgery

Issue 6

2019 Issue 6

Most read in this issue
Forgotten password

Enter the email address that you registered with. We will send you instructions on how to set a new password.


Don‘t have an account?  Create new account