Conservative Care for Cervical Spine MyelopathyNarrowing of the spinal canal called stenosis occurs naturally with aging. Thickening of the ligament along the spine and bone spurs can contribute to this problem. If the canal narrows too much, then pressure on the spinal cord can cause neck and arm pain, weakness, and numbness. This condition is called cervical spine myelopathy (CSM).
It has long been thought that surgery is the only way to effectively treat CSM. If the bone spurs aren't removed, the pressure won't ease. But the results of this report suggest otherwise. It's not only possible to keep CSM from getting worse with nonoperative care, symptoms can actually reverse with mild CSM.
Dr. P.G. Matz from the University of Alabama (Division of Neurosurgery) took the time to review and summarize studies published on CSM. Research shows that CSM is caused by many factors. It's more severe when three or more spinal segments are involved.
Static (unchanging) factors include congenital stenosis (present at birth) and degenerative changes (from aging). Dynamic factors from abnormal motion or flabby ligament can also contribute to the problem.
With rest, activity or postural changes, and a collar, as many as one-third of the patients studied showed improvement. An even larger number of patients stabilized and didn't get worse. Age and degree of severity may make a difference. Younger patients (less than 60 years old) with mild disease have the best results with conservative care.
Future studies are needed to compare the natural process of CSM with and without treatment. Sorting out what works best is next. The effect of surgery, immobilization, physical therapy, and psychologic support must be studied one at a time and then compared with the rest.
And finally, the effects of age, duration of symptoms, and severity of disease must be identified. This information would help doctors choose which patients would do best with each type of treatment. For now there's enough evidence to suggest that surgery may not be the only answer to this very complex problem.
Paul G. Matz, MD: Does Nonoperative Management Play a Role in the Treatment of Cervical Spondylotic Myelopathy? In The Spine Journal. November/December 2006. Vol. 6. No. 6S. Pp. 175S-181S.
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