Understanding the Mechanisms of Myelopathy

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Understanding the Mechanisms of Myelopathy

Cervical degenerative changes, including spondylarthrosis, disc degeneration, and apophyseal joint osteoarthritis are common in the elderly population. Previous studies have shown that older patients show C3-C4 pathology at a strikingly higher rate than younger patients, although the factors responsible for this difference remain unclear.

This study utilized radiographic analysis to evaluate the morphologic features predisposing patients to disorders at the C3-C4 motion segment. Specifically, the authors compared radiographic features in 18 elderly patients with cervical spondylotic myelopathy (CSM), 18 younger patients (less than 50 years of age) with myelopathy, and 30 healthy elderly volunteers. Range of intervertebral motion was assessed at each motion segment using active flexion-extension radiographs. Results are presented as follows:

Patients with CSM (both older and younger patients) were more likely to have a C3-C4 lesion than volunteer subjects.
These patients also had smaller spinal canals and greater C3-C4 segmental angulation, associated with age-related postural changes.
Functional radiographs revealed more mobility at the C3-C4 motion segment and less mobility at the lower segments.
Myelopathy was explained by spinal stenosis accompanied by C3-C4 hypermobility.

Mihara H, Ohnari K, Hachiya M, et al. Cervical myelopathy caused by C3-C4 spondylosis in elderly patients. A radiographic analysis of pathogenesis. Spine 2000:25(7), pp796-800.