Cervical Spondylotic Myelopathy (CSM) : Chiropractic Biophysics Patient Resources

Figure 1.

What is Cervical Spondylotic Myelopathy?

Cervical Spondylotic Myelopathy or CSM is a condition where the spinal cord in the neck (cervical region) is compressed and pinched by either bone spurs (arthritis in the neck), herniated discs, or by other tissues such as a tumor. See Figure 1. The sustained pinching pressures acting on the spinal cord eventually cause damage to the nerves and these begin to breakdown and deteriorate resulting in a diverse range of symptoms.^1,2

Who does it affect?

Typically CSM occurs in older generally over the age of 55. In fact, it is the most common spinal cord disorder in people who are over 55 years of age.

What are the symptoms/signs of CSM?

CSM is comprised of a very diverse symptom complex that may include spasticity or weakness of the upper and lower extremities, loss of sensation, loss of coordination, and/or sphincter disturbances. As the spinal cord compression increases in the neck, symptoms can possibly travel into the legs causing weakness and numbness. See Figure 1. Patients with CSM may have radiating pain into the arm or leg however, radiation of pain alone does not indicate that a patient has myelopathy.^1,2

The typical presentation of CSM is such that clinical symptoms have not developed fully at the time of initial presentation to a health care provider or these conditions have slowly developed over a period of months or years and the patient does not recognize the seriousness of the condition. Symptoms associated with CSM include the following:

· Muscle weakness,

· Spasticity of the upper and/or lower extremities,

· Decreased extremity reflexes,

· Loss of sensation,

· In some cases, a loss of coordination of movement in the legs during walking is found,

· In more severe cases loss of sphincter function may occur,

· The symptoms may not appear for several weeks after noticing the initial symptoms.

· In some cases this condition leads to progressive deterioration regardless of any particular type of treatment and in cases where no treatment is applied.^1,2

What is the cause CSM?

Compression of the spinal cord can occur resulting in a narrowing of the space for the nerves called spinal stenosis. Generally, the vertebrae have grown bone spurs or the patient may have herniated discs that are putting pressure on the spinal cord. Significant abnormal posture and reversed neck curves can cause pulling and stretching of spinal cord forcing it to contact the bone spurs or disc herniations creating CSM. Spinal tumors may also cause cord compression. Thus, the primary causes of CSM are:

· Bone spurs causing stenosis and pinching of the spinal cord,

· Disc hernitations causing stenosis and pinching of the spinal cord,

· Tumors inside the spinal canal where the space is for the spinal cord,

· Reversal of the normal cervical curve (neck curve) and abnormal posture of the head and neck can contribute to the symptoms of CSM. See Figure 2.³

Figure 2. Shown in A, is the human spinal column from the side showing you perspective for where the neck or cervical spine is located. In B, a large view of an x-ray of the normal curvature of the neck from the side view is shown. The white circle around the man’s neck shows you what part of the spine you are looking at. The Person is looking to the readers left. This normal curvature is called a Cervical Lordosis. There is a red circular arc along the neck bones showing the normal curvature of the cervical lordosis (neck curve) from the side.

Shown in C, is an abnormal cervical curvature. Abnormal cervical curvatures can contribute to the cause of Cervical Spondylotic Myelopathy (CSM).³ The nerves in the neck can be stretched and irritated from loss of the cervical curve. Importantly, the neck nerves travel down into the arm, hand, and legs, and when neck nerves become damaged you may feel symptoms in many regions. Only spinal x-rays can show a Chiropractor what the state of your neck curve is.

Chiropractic examination procedures to investigate the causes:

Your doctor of chiropractic will most likely perform a medical history, postural and biomechanical analysis, orthopedic and neurologic tests, x-rays, and should send out for either a non-weight bearing (lying on your back) or a standing motion MRI and or CT scan.

Treatment Procedures that DC's commonly use

Treatment for CSM may consist of:

· Joint Manipulations,

· Postural Rehabilitation,

· Decompression traction or stretching upwards,

· Stretching of the neck and extremities;

· ROM Exercises;

· Massage Technique (Myofascial release);

· Nutritional supplements to help with inflammation and nerve recovery.

Common Medical Interventions for CSM

Common medication interventions can include bracing with a soft collar to prevent neck motion, physical therapy, anti-inflammatory drugs, and cortico-steroids. Due to the common adverse risks associated with anti-inflammatory drugs (stomach bleeding, kidney damage, premature death, etc…)⁴ a patient may wish to try other conservative treatments first. In severe cases surgery is usually recommended to remove the bone spur and/or disc herniations that are putting pressure on the spinal cord. See Figure 1. However, surgery for CSM is not without risk.

In 2002, a review⁵of the literature on the efficacy of surgery in cases with Cervical Spondylotic Myelopathy was published. Their⁵ conclusion is striking:

“The available small randomized trials do not provide reliable evidence on the effects of surgery for cervical spondylotic radiculopathy or myelopathy. It is not clear whether the short-term risks of surgery are offset by any long-term benefits.”⁵

According to Fouyas et al⁵ the risk of death from surgical intervention for CSM cases has been reported to be as high as 2% and complication rates (morbidity) as high as 8%, for a total 10% complication rate.

Chiropractic Care May Positively Influence Cervical Spondylotic Myelopathy (CSM)

Chiropractic adjustments and rehabilitation procedures may offer a safer and just as effective means of an initial course of treatment for patients suffering from Cervical Spondylotic Myelopathy (CSM). Several case reports and review articles have shown the potential benefits of chiropractic care for improving CSM in the short term.^6-10 Significantly, Chiropractic BioPhysics^®(CBP^®) Technique care may have promising ability to improve patients suffering from signs and symptoms of CSM in specific cases.^9-10

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References

1. Brower RS. Differential diagnosis of cervical radiculopathy and myelopathy. In: Clark CR. The Cervical Spine. 4^th edition. Lippincott Williams & Wilkins; Philadelphia. 2005; page 998.

2. Muller A, Dvorak J. Chapter 6. Neurologic symptoms. In: Szpalski M and Gunzburg R. The Degenerative Cervical Spine. Lippincott Williams & Wilkins, Philadelphia 2001. pages: 73-82.

3. Ferch RD, Shad A, Cadoux-Hudson TA, Teddy PJ. Anterior correction of cervical kyphotic deformity: effects on myelopathy, neck pain, and sagittal alignment. J Neurosurg Spine. 2004;100(1):13-19.

4. Moore TJ, Cohen MR, Furberg CD. Serious adverse drug events reported to the food and drug administration; 1998-2005. Archives Internal Med 2007;167(16):1752-1759.

5. Fouyas IP, Statham PFX, Sandercock PAG. Cochrane review on the role of surgery in cervical spondylotic radiculomyelopathy. Spine 2002;27:736-747.

6. Sully, Charles L DC. Chiropractic-My profession: Case Study 6. 1951; :37-67.

7. Crawford, Colin M; Cassidy, David J. DC; Burns, Stephen DC. Cervical Spondylotic Myelopathy: A Report Of Two Cases. Chiropractic Journal Of Australia 1995; 25:101-110.

8. Patel, Sanjay N, DC; Kettner, Norman W, DC; Osbourne, Corey A, DC. Myelopathy: A Report of Two Cases. 2005; :539-546.

9. Heun S, Ferrantelli J. Chronic Antalgia vs. Posture for CSM patients—The CBP^Ò Perspective. AJCC July 2002, pgs. 21-23.

10. Harrison DE. Point of View with a Case with chronic severe CSM. AJCC Oct 2002.

Disclaimer

The primary purpose of this list of and general discussion of health conditions is to inform the public of the possibility that use of Chiropractic care may be associated with positive improvements in a variety of health conditions for patients actively undergoing Chiropractic care. Many of these symptoms require co-management and/or referrals to other health care specialists. This information is not intended, nor should it be used, to diagnose or treat any individual’s unique health condition.

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