[Cervical myelopathy: anatomopathology, clinical aspects and therapy]

Cervical myelopathy is a condition in which progressive compression of the spinal cord occurs going hand in hand with ongoing degenerative changes of the cervical segment of the spine. The degenerative changes start with a progressive degeneration of the disc, leading to a sometimes very severe narrowing of the cervical canal, mostly by osteophytes growing from the posterior edge of the vertebrae. Surgical decompression of the spinal cord is mandatory, as soon as the lesion is recognizable. In the same age group of patients with cervical myelopathy (i.e. aged between 50 and 70 years), primary degenerative lesions of the spinal cord, such as primary spastic progressive paralysis or amyotrophic lateral sclerosis, can occur. They resemble the cervical myelopathy closely. In that age group, everybody's cervical spine is degenerated to some degree; therefore, patients with primary and not compressive lesions of the spinal cord in the cervical tract are very often unnecessarily operated upon. Even if a pathognomonic neurologic pattern of cervical myelopathy does probably not exist, many of the more frequent symptoms and signs permit to lay out a profile of it, which may help to select the patients suitable for surgery as well as to avoid unnecessary and dangerous operations.