Kim Min Woo, Kang Chang-Nam, Choi Sung Hoon
Department of Orthopaedic Surgery, Busan Medical Center, Pusan, Korea.
Department of Orthopaedic Surgery, Hanyang University College of Medicine, Seoul, Korea.
Asian Spine J. 2023 Feb;17(1):213-221. doi: 10.31616/asj.2022.0440. Epub 2023 Feb 15.
Cervical myelopathy is a clinical syndrome resulting in symptoms of neurologic deficits due to prolonged spinal cord compression or ischemia in the cervical spine. Spinal cord compression can be caused by ossification of the posterior longitudinal ligament and hypertrophy of ligamentun flavum in addition to degenerative cervical spondylosis, degenerative disc disease, and progressive cervical kyphosis. Degenerative cervical myelopathy (DCM) is a series of disease entities caused by spinal cord compression by various nontraumatic and non-infectious causes. The pathophysiology of DCM includes spinal cord structure and function abnormalities caused by both static and dynamic factors. Surgical decompression for patients with moderate to severe cervical myelopathy not only inhibits the progression of neurological deterioration, but also improves functional status, pain, and quality of life. However, the role of nonsurgical treatment in patients with mild spinal cord compression is controversial. In general, patients with cervical myelopathies who do not undergo surgery have a poor prognosis. Appropriate surgical treatment is recommended when spinal cord compression is confirmed on image study in patients with reasonable symptoms of cervical myelopathy. The patient's overall health, degree of compression, presence of concurrent cervical radiculopathy, and cervical spine alignment, in addition to lesion location and etiology, should be considered when determining an appropriate surgical procedure. This review covers the updated issues, including pathophysiology, clinical manifestations, differential diagnosis, and available treatments for DCM.
脊髓型颈椎病是一种临床综合征，由于颈椎脊髓长期受压或缺血导致神经功能缺损症状。除了退行性颈椎病、椎间盘退变疾病和进行性颈椎后凸外，脊髓受压还可由后纵韧带骨化和黄韧带肥厚引起。退行性脊髓型颈椎病（DCM）是由各种非创伤性和非感染性原因导致脊髓受压引起的一系列疾病实体。DCM的病理生理学包括由静态和动态因素引起的脊髓结构和功能异常。对中重度脊髓型颈椎病患者进行手术减压不仅可以抑制神经功能恶化的进展，还可以改善功能状态、疼痛和生活质量。然而，非手术治疗在轻度脊髓受压患者中的作用存在争议。一般来说，未接受手术治疗的脊髓型颈椎病患者预后较差。当影像学检查证实脊髓受压且患者有合理的脊髓型颈椎病症状时，建议进行适当的手术治疗。在确定合适的手术方案时，除了病变位置和病因外，还应考虑患者的整体健康状况、受压程度、是否并发颈椎神经根病以及颈椎排列情况。本综述涵盖了DCM的最新问题，包括病理生理学、临床表现、鉴别诊断和可用治疗方法。
