Management of cervical spondylotic myelopathy with insights from metabolic imaging of the spinal cord and brain.

PURPOSE OF REVIEW: Cervical spondylotic myelopathy (CSM) is a potentially debilitating disorder primarily related to spinal cord injury caused by degenerative changes of the spine. As the population continues to age and live longer, it is likely that this disorder will be encountered with increasing frequency.

RECENT FINDINGS: Surgical management continues to be a mainstay of treatment of CSM patients, but some studies have indicated that nonoperative treatment may be equivalent to surgical management in some patients. Recent advances in neuroimaging of the spinal cord and brain have provided novel information regarding the pathogenesis of CSM, as well as compensatory mechanisms to preserve neurological function.

SUMMARY: CSM is a complex disorder whose incidence is likely to increase in coming years. Prospective, randomized studies are required to help establish the optimal treatment paradigm. Recent advances such as novel neuroimaging techniques and the continued development of neural repair strategies to treat the secondary biological injury associated with this disorder are likely to play key roles in the future management of CSM.