Degenerative cervical myelopathy

### What you need to know A 54 year old man presents with neck stiffness for about a year. He complains of numbness in his fingers and difficulty buttoning up his shirt, which has not improved following surgery for carpal tunnel syndrome. Of late, he has experienced unsteadiness and has started to use a walking stick after sustaining falls. He sees a neurologist who identifies hyperreflexia in his arms and legs. An MRI scan shows multilevel cervical spondylosis and disc herniation causing cord compression. He is diagnosed with degenerative cervical myelopathy and referred to spinal surgery for operative decompression. Degenerative cervical myelopathy (DCM), earlier referred to as cervical spondylotic myelopathy, involves spinal cord dysfunction from compression in the neck.1 Patients report neurological symptoms such as pain and numbness in limbs, poor coordination, imbalance, and bladder problems. Owing to its mobility, the vertebral column of the neck is particularly prone to degenerative changes such as disc herniation, ligament hypertrophy or ossification, and osteophyte formation. These changes are more common with age2 (box 1) and are often collectively termed spondylosis (fig 1).3 Box 1 ### How common is it? The epidemiology of DCM is poorly understood, in part because of the difficulties in diagnosis.3RETURN TO TEXT