Myelopathy due to degenerative and structural spine diseases

PURPOSE OF REVIEW: This article reviews the current evaluation and treatment of patients with myelopathy due to cervical spondylotic disease and other structural disorders of the spine. RECENT FINDINGS: In patients with cervical spondylotic myelopathy, symptom duration, severity at baseline, and possibly age have been identified as key prognostic markers of clinical course and postsurgical outcome. Other potential markers include specific MRI and EMG findings. The diagnosis and monitoring of syringomyelia is enhanced by the addition of phase contrast MRI, which evaluates CSF flow dynamics. Flexion MRI is helpful in establishing the diagnosis of Hirayama disease, which is now attributed to a tightened dural sac that is displaced anteriorly on neck flexion, compressing the cord. SUMMARY: Advances in neuroimaging along with new insights into the pathophysiology of structural spine diseases can help guide clinical decision making and optimize patient outcomes.