Cervical spondylotic myelopathy (CSM) is a compression of the spinal cord in the neck. (When doctors say the spinal cord is 'compressed,' they mean it is being pressed and squeezed.)
CSM often affects older adults. In people with CSM, changes in the bones, disks and ligaments of the spine cause pressure on the spinal cord. Some changes are because of normal aging. Some changes are caused by arthritis of the spine. CSM is the most common spinal cord problem in people 55 years or older in the United States.
Symptoms of CSM may develop slowly. Some symptoms of CSM may include neck stiffness, arm pain, numbness in the hands and weakness of the arms and legs. A person with CSM may have stiff legs. CSM may make it difficult for a person to use his or her hands or to walk steadily. Myelopathy affects the nerve tracts that run inside the spinal cord and deficits in these long tracts can be picked up on physical exam.
Your doctor will do a physical exam to see if you have CSM. He or she will look for changes in your strength, reflexes and ability to feel. Magnetic resonance imaging (MRI) is a way of "taking pictures" of your spine and can help confirm that you have spinal cord compression in your neck. The MRI can also show other problems such as tumors that cause symptoms similar to CSM. If your doctor is not sure that you have CSM, he or she can do other tests. Your doctor may also want you to see a neurologist
If CSM is not treated, it will usually stay the same or get worse. There's no way to predict whether it will get worse. Your doctor will talk with you about the pros and cons of the treatment options. Mild cases of CSM can be treated with neck braces or neck traction, but it's not clear whether these treatments help in the long run. Surgery to reduce the compression of the spinal cord may help some people, but it doesn't help everyone. Medicines can relieve pain caused by CSM, but they don't help other symptoms such as weakness or numbness.
Unfortunately, most conservative treatments are unlikely to be of much benefit and the symptoms rarely improve without surgery to decompress the affected area.