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Chapter 16 - Degenerative Cervical Myelopathy

from Section 2 - Clinical Neurosurgical Diseases

Published online by Cambridge University Press:  04 January 2024

By
T.J. Florence ,
Joel S. Beckett  and
Langston T. Holly
Edited by
Farhana Akter ,
Nigel Emptage ,
Florian Engert  and
Mitchel S. Berger
Farhana Akter
Affiliation:
Harvard University, Massachusetts
Nigel Emptage
Affiliation:
University of Oxford
Florian Engert
Affiliation:
Harvard University, Massachusetts
Mitchel S. Berger
Affiliation:
University of California, San Francisco
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Summary

Degenerative cervical myelopathy(DCM) is the most debilitating form of degenerative disc disease, and is the most common acquired cause of spinal cord dysfunction in adults. DCM is caused by progressive abnormalities of the vertebral column that result in spinal cord damage due to both primary mechanical and secondary biological injury. DCM pathohistology demonstrates a consistent pattern of deleterious changes including severe Wallerian degeneration cephalad and caudal to the level of compression, apoptotic oligodendrocyte cell loss, and anterior horn dropout. Spinal cord ischemia and hypoxia play a major role in DCM pathogenesis. Novel spinal cord imaging studies such as MR spectroscopy and diffusion tensor imaging have provided novel insights into the neurobiology of this disorder. The central nervous system effects of DCM not only involve the spinal cord, but also include upstream functional and structural alterations that can influence disease progression and response to surgical intervention.

Type
Chapter
Information
Neuroscience for Neurosurgeons , pp. 239 - 247
Publisher: Cambridge University Press
Print publication year: 2024

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References

Adams, MM, Hicks, AL. Spasticity after spinal cord injury. Spinal Cord 2005;43(10):577–86. https://doi.org/10.1038/sj.sc.3101757.Google Scholar
Baron, EM, Young, WF. Cervical spondylotic myelopathy: a brief review of its pathophysiology, clinical course, and diagnosis. Neurosurgery 2007;60(1_Suppl.):35–42. https://doi.org/10.1227/01.NEU.0000215383.64386.82.CrossRefGoogle Scholar
Brain, R, Knight, GC, Bull, JWD. Discussion on rupture of the intervertebral disc in the cervical region. J R Soc Med 1948;41(8):509–16.Google Scholar
Breig, A, Turnbull, I, Hassler, O. Effects of mechanical stresses on the spinal cord in cervical spondylosis. A study on fresh cadaver material. J Neurosurg 1966;25(1):45–56. https://doi.org/10.3171/jns.1966.25.1.0045.Google Scholar
Carette, S, Fehlings, MG. Cervical radiculopathy. N Engl J Med 2005;353(4):392–9. www.nejm.org/doi/abs/10.1056/NEJMcp043887Google Scholar
Chao, EYS. Biomechanics of the human gait. In Frontiers in Biomechanics. Springer, 1986: 225–44. https://doi.org/10.1007/978-1-4612-4866-8_17Google Scholar
Chen, I-H, Vasavada, A, Panjabi, MM. Kinematics of the cervical spine canal. J Spinal Disord 1994;7(2):93–101. http://journals.lww.com/00002517-199407020-00001Google Scholar
Choi, BW, Song, KJ, Chang, H. Ossification of the posterior longitudinal ligament: a review of literature. Asian Spine J 2011;5(4):267–76. https://doi.org/10.4184/asj.2011.5.4.267.Google Scholar
Clarke, E, Robinson, PK. Cervical myelopathy: a complication of cervical spondylosis. Brain 1956;79(3):483–510. https://doi.org/10.1093/brain/79.3.483.Google Scholar
Crandall, PH, Batzdorf, U. Cervical spondylotic myelopathy. J Neurosurg 1966;25(1):57–66. https://doi.org/10.3171/jns.1966.25.1.0057.Google Scholar
Dietz, V. Proprioception and locomotor disorders. Nat Rev Neurosci 2002;3(10):781–90. https://doi.org/10.1038/nrn939.Google Scholar
Dietz, V. Spinal cord pattern generators for locomotion. Clin Neurophysiol 2003;114(8):1379–89. https://doi.org/10.1016/s1388-2457(03)00120-2.Google Scholar
Ellingson, BM, Salamon, N, Woodworth, DC, Yokota, H, Holly, LT. Reproducibility, temporal stability, and functional correlation of diffusion MR measurements within the spinal cord in patients with asymptomatic cervical stenosis or cervical myelopathy. J Neurosurg Spine 2018;28(5):472–80. https://doi.org/10.3171/2017.7.SPINE176.Google Scholar
Ellingson, BM, Woodworth, DC, Leu, K, Salamon, N, Holly, LT. Spinal cord perfusion MR imaging implicates both ischemia and hypoxia in the pathogenesis of cervical spondylosis. World Neurosurg 2019;128:e773–81. https://doi.org/10.1016/j.wneu.2019.04.253Google Scholar
Fehlings, MG, Skaf, G. A review of the pathophysiology of cervical spondylotic myelopathy with insights for potential novel mechanisms drawn from traumatic spinal cord injury. Spine (Phila Pa 1976) 1998;23(24):2730–7. https://doi.org/10.1097/00007632-199812150-00012.Google Scholar
Gooding, MR, Wilson, CB, Hoff, JT. Experimental cervical myelopathy. Effects of ischemia and compression of the canine cervical spinal cord. J Neurosurg 2009;43(1):9–17. https://doi.org/10.3171/jns.1975.43.1.0009.CrossRefGoogle Scholar
Hayashi, H, Okada, K, Hamada, M, Tada, K, Ueno, R. Etiologic factors of myelopathy. A radiographic evaluation of the aging changes in the cervical spine. Clin Orthop Relat Res 1987;214:200–09. www.ncbi.nlm.nih.gov/pubmed/3791744Google Scholar
Henneman, E, Olson, CB. Relations between structure and function in the design of skeletal muscles. J Neurophysiol 1965;28:581–98. https://doi.org/10.1152/jn.1965.28.3.581.CrossRefGoogle ScholarPubMed
Holly, LT, Dong, Y, Albistegui-Dubois, R, Marehbian, J, Dobkin, B. Cortical reorganization in patients with cervical spondylotic myelopathy. J Neurosurg Spine 2007;6(6):544–51. https://thejns.org/view/journals/j-neurosurg-spine/6/6/article-p544.xmlGoogle Scholar
Holly, LT, Ellingson, BM, Salamon, N. Metabolic imaging using proton magnetic spectroscopy as a predictor of outcome after surgery for cervical spondylotic myelopathy. Clin Spine Surg 2017;30(5):E615–9. https://doi.org/10.1097/BSD.0000000000000248.Google Scholar
Holly, LT, Freitas, B, McArthur, D, Salamon, N. Proton magnetic resonance spectroscopy to evaluate spinal cord axonal injury in cervical spondylotic myelopathy. J Neurosurg Spine 2009;10:194–200. https://doi.org/10.3171/2008.12.SPINE08367.CrossRefGoogle ScholarPubMed
Kandel, E, Schwartz, J, Jessell, TM. Principles of Neural Science. 4th ed. New York: McGraw-Hill; 2000.Google Scholar
Karadimas, S, Gialeli, C, Klironomos, G, et al. The role of oligodendrocytes in the molecular pathobiology and potential molecular treatment of cervical spondylotic myelopathy. Curr Med Chem 2010;17(11):1048–58. https://doi.org/10.2174/092986710790820598.Google Scholar
Karadimas, SK, Gatzounis, G, Fehlings, MG. Pathobiology of cervical spondylotic myelopathy. Eur Spine J 2015;24(2):132–8. https://doi.org/10.1007/s00586-014-3264-4.CrossRefGoogle ScholarPubMed
Karadimas, SK, Moon, ES, Yu, WR, et al. A novel experimental model of cervical spondylotic myelopathy (CSM) to facilitate translational research. Neurobiol Dis 2013;54:43–58. http://dx.doi.org/10.1016/j.nbd.2013.02.013Google Scholar
Lemon, R. Cortical control of the primate hand. Exp Physiol 1993;78(3):263–263. https://doi.org/10.1113/expphysiol.1993.sp003686.CrossRefGoogle ScholarPubMed
Little, JW, Ditunno, JF, Stiens, SA, Harris, RM. Incomplete spinal cord injury: neuronal mechanisms of motor recovery and hyperreflexia. Arch Phys Med Rehabil 1999;80(5):587–99. https://doi.org/10.1016/s0003-9993(99)90204-6.Google Scholar
Madhav, MS, Cowan, NJ. The synergy between neuroscience and control theory: the nervous system as inspiration for hard control challenges. Annu Rev Control Robot Auton Syst 2020;3(1):243–67. https://doi.org/10.1146/annurev-control-060117-104856.CrossRefGoogle Scholar
Mair, WGP, Druckman, R. The pathology of spinal cord lesions and their relation to the clinical features. Brain 1953;76(1):70–91. https://doi.org/10.1093/brain/76.1.70.CrossRefGoogle ScholarPubMed
Martin, J. Neuroanatomy (Text and Atlas). 3rd ed. McGraw-Hill Medical; 2003.Google Scholar
McCormack, BM, Weinstein, PR. Cervical spondylosis – an update. West J Med 1996;165(1–2):43–51.Google Scholar
Mendell, LM. The size principle: a rule describing the recruitment of motoneurons. J Neurophysiol 2005;93(6):3024–6. https://doi.org/10.1152/classicessays.00025.2005.Google Scholar
Mihara, H, Ohnari, K, Hachiya, M, Kondo, S, Yamada, K. Cervical myelopathy caused by C3–C4 spondylosis in elderly patients: a radiographic analysis of pathogenesis. Spine (Phila Pa 1976) 2000;25(7):796–800. https://doi.org/10.1097/00007632-200004010-00006.Google Scholar
Moore, AP, Blumhardt, LD. A prospective survey of the causes of non-traumatic spastic paraparesis and tetraparesis in 585 patients. Spinal Cord 1997;35(6):361–7. https://doi.org/10.1038/sj.sc.3100422.Google Scholar
Muthukumar, N. Ossification of the ligamentum flavum as a result of fluorosis causing myelopathy: report of two cases. Neurosurgery 2005;56(3):E622. https://doi.org/10.1227/01.NEU.0000154062.14313.6D.Google Scholar
Nurick, S. The pathogenesis of the spinal cord disorder associated with cervical spondylosis. Brain 1972;95(1):87–100. https://doi.org/10.1093/brain/95.1.87.CrossRefGoogle ScholarPubMed
Ogino, H, Tada, K, Okada, K, et al. Canal diameter, anteroposterior compression ratio, and spondylotic myelopathy of the cervical spine. Spine (Phila Pa 1976) 1983;8(1):1–15. https://doi.org/10.1097/00007632-198301000-00001.CrossRefGoogle ScholarPubMed
Park, E, Velumian, AA, Fehlings, MG. The role of excitotoxicity in secondary mechanisms of spinal cord injury: a review with an emphasis on the implications for white matter degeneration. J Neurotrauma 2004;21(6):754–74. https://doi.org/10.1089/0897715041269641.Google Scholar
Rao, R. Neck pain, cervical radiculopathy, and cervical myelopathy. J Bone Jt Surg Am 2002;84(10):1872–81. https://doi.org/10.2106/00004623-200210000-00021.Google Scholar
Salamon, N, Ellingson, BM, Nagarajan, R, Gebara, N, Thomas, A, Holly, LT. Proton magnetic resonance spectroscopy of human cervical spondylosis at 3T. Spinal Cord 2013;51(7):558–63. https://doi.org/10.1038/sc.2013.31.Google Scholar
Santillan, A, Nacarino, V, Greenberg, E, Riina, HA, Gobin, YP, Patsalides, A. Vascular anatomy of the spinal cord. J Neurointerv Surg 2012;4(1):67–74.Google Scholar
Sherrington, CS. The Integrative Action of the Nervous System. Yale University Press, 1906.Google Scholar
Sherrington, CS. Flexion–reflex of the limb, crossed extension–reflex, and reflex stepping and standing. J Physiol 1910;40(1–2):28–121. https://doi.org/10.1113/jphysiol.1910.sp001362.Google Scholar
Shi, R, Pryor, JD. Pathological changes of isolated spinal cord axons in response to mechanical stretch. Neuroscience 2002;110(4):765–77. https://doi.org/10.1016/s0306-4522(01)00596-6.Google Scholar
Stookey, B. Compression of the spinal cord due to ventral extradural cervical chondromas: diagnosis and surgical treatment. Arch Neurol Psychiatry 1928;20(2):275–91. https://doi.org/10.1001/archneurpsyc.1928.02210140043003.CrossRefGoogle Scholar
Stys, PK. Anoxic and ischemic injury of myelinated axons in CNS white matter: from mechanistic concepts to therapeutics. J Cereb Blood Flow Metab 1998;18(1):2–25. https://doi.org/10.1097/00004647-199801000-00002.Google Scholar
Taylor, AR. Mechanism and treatment of spinal-cord disorders associated with cervical spondylosis. Lancet 1953;261(6763):717–20. https://linkinghub.elsevier.com/retrieve/pii/S0140673653918479Google Scholar
Whelan, PJ. Control of locomotion in the decerebrate cat. Prog Neurobiol 1996;49(5):481–515. https://doi.org/10.1016/0301-0082(96)00028-7.CrossRefGoogle ScholarPubMed
Woodworth, DC, Holly, LT, Mayer, EA, Salamon, N, Ellingson, BM. Alterations in cortical thickness and subcortical volume are associated with neurological symptoms and neck pain in patients with cervical spondylosis. Clin Neurosurg 2019;84(3):588–97. https://doi.org/10.1093/neuros/nyy066.CrossRefGoogle ScholarPubMed
Zaaimi, B, Edgley, SA, Soteropoulos, DS, Baker, SN. Changes in descending motor pathway connectivity after corticospinal tract lesion in macaque monkey. Brain 2012;135(7):2277–89. https://doi.org/10.1093/brain/aws115.Google Scholar

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