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Does cervical myelopathy always get worse?

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Q: I've been told that the neck and arm pain I have is from a condition called cervical myelopathy. No one seems able to tell me if I'll get better or not. What happens to most people with this problem?

A: CSM is a degenerative condition that occurs with aging. Adults affected most often are 50 years old and older. The term myelopathy refers to any problem that affects the spinal cord. Cervical tells us the area affected is the cervical spine (neck region). Spondylotic or spondylosis describes a narrowing of the spinal canal where the spinal cord is located.

So, basically what we are describing is a narrowing of the spinal canal that puts pressure on the spinal cord. That's what causes your neck pain, arm pain, and sensory symptoms such as numbness and tingling down the arm. Some patients also report a shock-like feeling down the arms when the head and neck are flexed. Pressure on the spinal cord causes this sensation called Lhermitte's sign.

So, what is the natural history of cervical spondylotic myelopathy? Natural history refers to what happens to a person with this type of problem as time goes by. Do they get better, worse, or stay the same? Can a person outgrow it? If it comes with aging, does it get worse as we get older?

Understanding the natural history of a condition is important. For example, if we know how a condition is going to respond over time, it's easier to predict which types of treatment would work best and which subgroups of patients would respond to those treatment approaches. Unfortunately good-to-high quality of evidence, has shown us that cervical spondylotic myelopathy can go any number of ways. In some cases, there is a slow decline over time. The patient seems to get worse, plateaus (stays the same) or may get slightly better, then declines even more. This pattern is referred to as a stepwise decline. In other cases, the patient is symptom-free or perhaps experiences no change in symptoms over a long period of time.

Is there some way to predict who will progress and get worse and who will stabilize/stay the same? For that matter, is it possible to predict if anyone with this degenerative problem will get better? After all, if it is age related, we can't reverse the effects of aging or stop the aging process. These are very good questions and ones you may have asking yourself. Here's what we know so far:

  1. Anyone who has this condition will probably get worse over time.
  2. As the spondylosis (narrowing of the spinal canal) gets worse, the risk of damage and even death of the spinal cord increases.
  3. Younger adults (less than 75 years old) seem better able to adapt and improve without surgery.
  4. For those patients (of any age) who got better with nonoperative (conservative) care, they are able to maintain these good results for three years or more.

The fact that this condition does seem to respond to early treatment is a good sign. It means patients can get the help they need to stabilize the condition and keep it from getting worse.

Reference: Paul G. Matz, MD, et al. The Natural History of Cervical Spondylotic Myelopathy. In Journal of Neurosurgery: Spine. August 2009. Vol. 11. No. 2. Pp. 104-111.

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