Cervical spondylotic myelopathy is a leading cause of spinal
cord dysfunction in the adult population. Affected patients
represent a large subset of individuals who undergo operative
treatment of degenerative cervical conditions. In a study of
450 patients undergoing anterior neck surgery for the treatment of degenerative disc disease, 61% presented with radicular symptoms, 16% had pure myelopathic symptoms, and the
remaining 23% had a combination of myelopathy and
The subtle clinical findings of early cervical spondylotic
myelopathy make diagnosis difficult, and true natural history
studies are unavailable. The patients or their relatives notice
increasing awkwardness with gait and balance that they attribute to old age or arthritis of the lower extremity joints. Patients may report an insidious onset of clumsiness or diffuse
numbness in the hands, resulting in worsening of handwriting
or other fine motor skills and difficulty with grasping or holding. Physical examination shows exaggerated deep tendon
reflexes, clonus, diminished superficial reflexes, and the presence of pathologic reflexes. Spasticity, motor weakness, and
loss of proprioception contribute to the functional disability
of the upper and lower limbs. Severely affected individuals are
quadriparetic or quadriplegic when first seen2
. In an effort to
describe the natural history of this condition, Clarke and Robinson described the progression of disease in a group of 120
patients (including thirty-seven patients who did not receive