Myélopathies cervicales

Cervical myelopathy is a clinical syndrome related to a cervical spinal stenosis; it is the most frequent type of myelopathy occurring after the age of 50. Cervical spondylosis is the main aetiology, but many other diseases may produce significant reduction of the size of the spinal canal and a myelopathy. Congenital stenosis can induce a myelopathy in rare cases, but it is often only a predisposition. Its physiopathology is unclear and associates mechanical compression, microtraumas and microvascular disturbances, in few cases, with a vertebral instability. The clinical signs combine the metameric syndrome with radicular signs and/or motoneuronal deficit, and a sublesional syndrome with pyramidal, spinothalamic and posterior cordonal tract impairment. Its evolution is responsible for a progressive handicap. X-ray and MRI are generally sufficient to establish the diagnosis. But in a few cases, CT scanning and computed myelography are necessary. Neurophysiology is useful in making differential diagnosis and may have a prognostic value. In some cases, benign and slightly progressive forms may be treated conservatively, but surgery is necessary in most cases. The choice of anterior or posterior approach is guided by the clinical symptoms and radiological findings. In Europe, the anterior approach is the most frequently used technique. The post operative prognosis is better when surgery is undergone early; post operative complications are very rare.