Cervical Spondylotic Myelopathy (CSM) Is The Most Complex Cervical Spine Disorder

Complex disorders of the cervical spine can be serious conditions that need to be properly managed by specialists.

The most common symptoms of cervical disorders are neck pain and a stiff neck. When nerves are involved, this can lead to a pressing pain, numbness, or weakness that goes down the shoulder, arm or hand.

When cervical disorders are not properly treated from the beginning, patients can develop more complex disorders. The consequences of improper treatment of cervical disorders can be high, including the inability to drive and impairment to the senses. To guard against the development of more serious, complex cervical spine disorders and the lack of functionality, it is important that the patient be assessed fully and treated appropriately.

Physicians at the USC Spine Center specialize in treating disorders of the cervical spine and understand the subtle differences that are involved in treating patients with these conditions. Our goal is to deliver appropriate spine care for all patients, including those with cervical disorders. We apply unique diagnostic and therapeutic techniques for conditions in the cervical spine. Each year, we treat more than 500 patients who have complex disorders of the cervical spine.

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When to consider surgery

Sometimes, the most conservative treatment for a cervical spine disorder is surgery because it is associated with the best patient outcomes; delaying surgery can be associated with the patient developing serious complications. Surgeons at the USC Spine Center have the expertise and technology to tailor surgeries to maximize the patient’s outcome while minimizing the impact of the procedure.

Image-guided navigation allows surgeons to perform procedures on the upper cervical spine and the back of the head or skull and place hardware in these delicate areas. When possible, our surgeons will perform a laminoplasty instead of a spinal fusion to attempt to preserve spinal mobility for the patient.

Image: A postoperative radiograph of a patient with severe spinal cord compression. When the patient came to the USC Spine Center, he was deteriorating and showing some signs of spinal cord damage, which were uncovered during his exam. Imaging studies confirmed that he had severe spinal cord compression. He also had instability of his upper cervical spine near the junction of the skull. After careful consultation and discussion of the different treatment options including non-operative treatment, the patient decided to undergo a surgical spinal decompression and cranial stabilization to the cervical and thoracic spine. Subsequently, the patient has regained spinal cord function and is doing well.

Our expertise in the treatment of cervical spine disorders encompasses everything from more common conditions, such as herniated disc or degenerative disc disease, to more complex conditions, such as cervical myelopathy. Cervical spondylotic myelopathy (CSM), one of the most serious conditions of the entire spine, is a deadly and sly disease that has a subtle presentation. If CSM is not treated appropriately and promptly, the patient may suffer disastrous consequences, such as disturbances when walking and loss of coordination. Conservative (non-operative) treatments have not been shown to be very effective at improving the motor and sensory disturbances associated with CSM.

Recent studies showed that surgical decompression to treat CSM was associated with improvements in patients’ functional and quality-of-life outcomes compared to baseline. Both anterior and posterior surgical approaches appear to be equally effective in treating CSM. This procedure is associated with complication rates of 15 to 18 percent, of which the most common complications were dysphagia, superficial infection, and cardiopulmonary issues.

The physicians of the USC Spine Center lead the field for treatment of these and other complex spinal disorders. We are conducting research for novel technologies and therapeutics that will hopefully make a clinical impact and improve patients’ lives.