Die zervikale spondylotische Myelopathie

Cervical spondylotic myelopathy is the most frequent cause of myelopathy in advanced age. It is caused by progressive degenerative changes of the cervical spine super-imposed on a developmentally narrow spinal canal. The typical clinical manifestations are characterized by radicular sensory and motor deficits in the arms and the signs of pyramidal tract dysfunction. The variable course of the disease and the lack of controlled clinical trials make it difficult to decide on the appropriate form of therapy. Only mild functional disturbances, lack of progression and old age justify an attempt to adopt conservative therapy based on immobilization, provided that close clinical follow up is used. If surgery is considered to be necessary, stenosis confined to < 3 segments should be treated by decompression using an anterior procedure, whereas a posterior approach is usually more promising for more extended stenosis.