Clinical Case Cervical Spondylotic Myelopathy
Cervical spondylotic myelopathy (CSM) is a condition characterized by the compression of the spinal cord, resulting from the narrowing of the spinal canal and degenerative changes.
This compression, which can be caused by factors related to development or dynamic factors, leads to the onset of CSM. CSM presents with typical signs such as pain in the neck and radiating pain, along with sensations of numbness and tingling, muscle weakness, and spasms in the upper limbs.
Additionally, CSM can give rise to notable neurological issues like impaired walking and dysfunction of the bladder. To ensure optimal treatment for patients, it is crucial to have a comprehensive understanding of the causes and progression of CSM.
CSM is typically caused by age-related degenerative changes in the spinal canal. While it is more common in older adults, a study aims to explore the characteristics of CSM in young adults under 30, as this population is rarely affected.
In a study reported by literature, a very small percentage (0.27%) of CSM patients under 30 years old were analyzed. They were mostly male and engaged in high daily activities that placed stress on their necks. Radiographs showed congenitally narrowed spinal canals and positive findings for dynamic spinal movements.
MRI scans revealed disc degeneration, spinal cord compression, and abnormal signal changes. The sagittal alignment of the cervical spine showed two common types, associated with different patterns of spinal cord compression and damage. These findings suggest that high daily activities and congenital canal stenosis can contribute to the development of symptomatic CSM in young adults.
Participating in sports activities, particularly contact sports like American football and rugby, is a significant contributor to spinal injuries among young individuals.
This study focused on patients who engaged in high daily activities related to sports or occupations, resulting in ongoing strain on their necks. Unlike cases with sudden onset symptoms, the patients in this study experienced a gradual development of symptoms over time.
This suggests that the consistent occurrence of mild daily injuries and traumas may play a role in the progression of degenerative spinal changes and the occurrence of subclinical neurological damage.
CSM risk is associated with congenitally narrowed cervical spinal canal stenosis. Measuring the sagittal spinal canal diameter on radiographs is a common method, and a diameter of 12 mm or less indicates a high risk of CSM development.
The Torg-Pavlov ratio is another indicator, and all patients in the study had a ratio <0.8, indicating a predisposition to congenital canal stenosis. While women have a higher prevalence of this condition, men engaged in high daily activities can experience spinal cord compression in the presence of congenital canal stenosis.
Dynamic canal stenosis, also referred to as the “pincer mechanism,” is an added risk factor for CSM. The study revealed that the majority of patients displayed positive indications of dynamic canal stenosis, suggesting that individuals with congenital canal stenosis and active daily routines may experience an intensified compression of the spinal cord.
The use of absolute radiographic measurements to assess cervical spine instability and canal stenosis is a topic of debate. However, there are suggested criteria for evaluating the space available for the spinal cord at the C1 level.
For patients who meet the radiographic criteria for instability and stenosis, it is advisable to undergo further MRI evaluation to support a comprehensive diagnosis of myelopathy involving multiple disciplines.
Magnetic resonance imaging (MRI) is a valuable diagnostic tool for examining intervertebral disc and spinal cord conditions. The study observed degeneration in all discs at the affected level, along with the presence of spinal cord compression, deformity, and intramedullary abnormal signal lesions.
These findings suggest that the combination of high daily activities, degenerative instability, and congenital canal stenosis can contribute to spinal cord compression and damage, potentially resulting in the development of symptomatic CSM.
The objective of this study was to examine the sagittal alignment of the cervical spine in young adult patients to identify radiographic and biomechanical characteristics of cervical spondylotic myelopathy (CSM).
The most frequently observed alignment was the “reverse-sigmoid” type, which exhibited single-level spinal cord compression and positive indications of decreased neutral foramen (DNF) or posterior vertebral slip. On the other hand, alignments such as “lordosis” or “straight” demonstrated multi-level spinal cord compression and altered biomechanics.
Therefore, it is crucial to closely monitor young male athletes and workers with pre-existing sagittal malalignment and congenital canal stenosis for the development of dynamic canal stenosis and spinal cord damage.
It is important to exercise caution when interpreting the findings of this study for several reasons. Firstly, the true prevalence of CSM in patients under the age of 30, including those with mild symptoms treated in outpatient settings, remains uncertain as the study only included hospitalized patients.
Secondly, the small sample size restricts the statistical power and increases the likelihood of potential interpretation errors, despite utilizing appropriate statistical analysis methods.
Thirdly, the absence of a control group limits the ability to draw definitive conclusions. Furthermore, the retrospective nature of the study introduces limitations and potential biases related to participant selection.
However, the distinct characteristics observed in young adult patients with non-herniated, degenerative CSM underscore the need for future prospective cohort studies to gain a more comprehensive understanding of this condition.
Non-herniated, degenerative cervical spondylotic myelopathy (CSM) is rare in young adults under 30. However, it is more common in men with congenital canal stenosis and mild sagittal deformities.
High daily activities, such as sports or jobs that stress the neck, can accelerate disc degeneration and dynamic canal stenosis, leading to spinal cord compression and potential symptomatic myelopathy.
I am Vedant Vaksha, Fellowship trained Spine, Sports and Arthroscopic Surgeon at Complete Orthopedics. I take care of patients with ailments of the neck, back, shoulder, knee, elbow and ankle. I personally approve this content and have written most of it myself.
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