Epidemiology

One of the most common types of cervical myelopathy is spondylotic

cervical myelopathy.
Cervical Spondylotic myelopathy is the most common disorder of the
spinal cord in persons older than 55 years of age.
There is radiologic spondylotic changes increase with patient older than
70 years of age have some form of degenerative change in the cervical
spine. Cervical spine myelopathy is caused by sagittal narrowing of the
spinal canal and compression of the spinal cord.
Epidemiology
The incidence and prevalence of spondylotic cervical myelopathy are
not well reported in the literature.
the incidence of hospitalization associated with cervical spondylotic
myelopathy is 4.04 per 100,000 people in East Asia (Wu et al 2013).
Asians are at high risk for cervical myelopathy
Etiology
Myelopathy is a term for the compression of the spinal cord, while
stenosis is a term describing a narrowing of canal. In the cervical spine,
certain patients are more predisposed to myelopathy due to a
narrowed spine cervical canal. The progression of stenosis or a cervical
disc herniation will results in myelopathy at this level.
Etiology
The causes of cervical myelopathy can be divided into several categories:
1. Static Factors
Narrowing of the spinal canal generally occurs as a result of degenerative changes in the
anatomy of the cervical spine (cervical spondylosis) such as disc degeneration, spondylosis,
stenosis, formation of ostephytes at the level of the facet joints, segmental ossification of the
posterior longitudinal ligament and ligament hypertrophy, calcification or ossification. Patients
with a narrow spinal canal (<13mm) are at high risk for developing symptoms of cervical
myelopathy.
2. Dynamic Factors
Due to mechanical abnormalities or cervical spine instability.
3. Vascular and Cellular Factors
Spinal cord ischaemia affects the oligodendrocytes, leading to demyelination which suggests a
chronic degenerative disorder. Glutamatergic toxicity, cell injury and apoptosis can also occur.
Etiology
Here are a picture of bone spurs and disc herniation

When the person is getting older, the discs also lose moisture, begin to dry out, and become
stiffer. The body responds to the disc by forming more bones called bone spurs around the disc
to strengthen it. These bone spurs contribute to hardening of the spine. They can also make the
spinal canal narrow and compress the spinal cord.

The disc herniates when the nucleus pulposus pushes against the annulus fibrosus. If the disc is
injured, the nucleus can compress completely. When a herniated disc protrudes towards the
spinal canal, it can put pressure on the spinal cord or nerve roots.

based on the journal that I read also said that that cervical myelopathy can be caused by
autoimmune disease, namely rheumatoid arthritis
Prognosis
A prospective study for 27 years showed that the average life expectancy of
patients with spinal cord injury was lower than in the normal population.
Decrease life expectancy according to injury severity.
The main causes of death are complications of neurological disabilities, for
example like pneumonia, pulmonary embolism, septicemia, and kidney
failure.
Patients with neck pain have radical symptoms after muscle dermatome are
more likely to improve after surgery than patients without radicular pain.
Approximately 65% of patients who experience neck pain and radicular
symptoms will benefit from surgical decompression.
Conclusion
Spinal cord injury is one of the main causes of neurological disability resulting from
trauma. This condition can affect various ages, but commonly found in elderly
patients, namely cervical myelopathy.
There are many causes of cervical myelopathy, and they are generally progressive. In
cases of myelopathy, examination of the local neurologic status is very important.
Treatment of spinal cord injury is primarily aimed at improving sensory and motor
function.
There are 2 therapies of cervical myelopathy, namely conservative therapy and
operative therapy. Conservative therapy is generally given to patients with high risk
of surgery or in a stable state with minimal symptoms that do not interfere daily
while operative therapy is highly dependent on the patient's condition.
Take Home Message
While CSM is the most common cause of myelopathy, especially in
older patients, many disorders can also cause myelopathy and must be
kept in the differential on initial workup. A focused history and physical
exam can direct the clinician toward the correct diagnosis, but the signs
and symptoms typically associated with CSM are not highly sensitive or
specific, and various clinical tests are generally required to differentiate
between CSM with the differential diagnoses, ex imaging mri.
Patients with symptomatic cervical myelopathy should be referred to a
spine surgeon for evaluation and management.
Conclusion 2
Myelopathy is a term used to describe the clinical syndrome present
when a disease process in or around the spinal cord and cervical
myelopathy occurs when the disease process affects the cervical spinal
cord and can manifest as symptoms in all four extremities.
There are many causes of cervical myelopathy but the most commonly
is canal stenosis because of degenerative changes commonly seen with
aging such as disc degeneration, spondylosis, stenosis, formation of
ostephytes, hypertropia facet joints, of the posterior longitudinal
ligament and ligament hypertrophy and so on.
Kesimpulan 2
Mielopati adalah istilah yang digunakan untuk menggambarkan
sindrom klinis yang muncul saat proses penyakit di dalam atau di
sekitar sumsum tulang belakang dan mielopati serviks terjadi ketika
proses penyakit memengaruhi sumsum tulang belakang servikal dan
dapat bermanifestasi sebagai gejala di keempat ekstremitas.
Ada banyak penyebab mielopati serviks tetapi yang paling umum
adalah stenosis kanal karena perubahan degeneratif yang biasa terlihat
dengan penuaan seperti degenerasi diskus, spondilosis, stenosis,
pembentukan ostefit, sendi facet hipertropia, dari ligamentum
longitudinal posterior dan hipertrofi ligamen dan sebagainya. .
Conclusion 2
In many patients, the earliest sign of myelopathy is gait stiffness or trouble with balance,
paresthesias, weakness or paresis, spasticity or sphincter disturbance and incontinence.
Beside of that bowel and bladder dysfunction is not often seen until the disease has
progressed in severity.
There has been long-standing debate over which in the treatment of multi- level CSM. In
general, no approach has been shown to be superior over the other to date. A recent
systematic review conducted by Lawrence et al. (2013) has upheld this finding, and
recommended surgical approach to the individual patients which is surgical decompression
can prevent progression of cervical spondylotic myelopathy, and in some patients improve
gait and hand function.
Kesimpulan 2
Pada banyak pasien, tanda awal mielopati adalah gaya berjalan kaku atau
gangguan keseimbangan, parestesia, kelemahan atau paresis, gangguan
spastisitas atau sfingter dan inkontinensia. Disamping itu disfungsi usus
dan kandung kemih jarang terlihat sampai penyakitnya semakin parah.
Telah ada perdebatan lama tentang penanganan CSM multi-level. Secara
umum, tidak ada pendekatan yang terbukti lebih unggul dari yang lain
hingga saat ini. Tinjauan sistematis terbaru yang dilakukan oleh Lawrence
et al. (2013) mendukung temuan ini, dan merekomendasikan pendekatan
bedah untuk pasien individu yaitu bedah dekompresi dapat mencegah
perkembangan mielopati spondilotik serviks, dan pada beberapa pasien
meningkatkan gaya berjalan dan fungsi tangan.