Managing Mild Myelopathy and Asymptomatic Cord Compression

Editorial Review by: James Demetrious, DC, DABCO

Clinical Need

Chiropractic physicians identify patients who present with myelopathic and non-myelopathic spinal cord compression due to spinal stenosis. Careful assessment provides insight into indications and contraindications of chiropractic care, improves patient management, and facilitates the referral of patients for neurosurgical consultation.

In their paper, Barber et al. provide a brief review of the literature and offer recommendations for the management of mild CSM and non-myelopathic cervical spinal cord compression. The authors based their recommendations on studies of the natural history of degenerative cervical stenosis and the factors that predict disease progression and treatment outcomes. [1]

Clinical Determinants

Increased pressure exerted upon the cervical spinal cord over time results in a reduction of spinal cord blood flow, ischemic changes, and a cascade of neuro-inflammatory events that occurs over time. The differential assessment in this patient cohort requires careful evaluation of radiographic findings of cervical stenosis and spinal cord compression. In addition, physicians must consider functional assessments that may provide further insight into progressively worsening cervical myelopathy.

Barber et al. provide descriptions of radiographic findings and evidence-based assessments of their clinical significance:

In addition, the authors provide insight into commonly used functional assessments of cervical myelopathy and the evidence-based scoring mechanisms attributed to each:

Guidelines from Barber et al. 

“The management of cervical stenosis and CSM depends primarily on clinical presentation and correlation with radiological findings. Moderate-to-severe CSM should typically be managed surgically. Conservative management with long-term observation of mild CSM and non-myelopathic cord compression is reasonable; clinical and radiological measures can help predict the risk of neurological deterioration in these patients and aid in clinical decision-making.” [1]

Recommendations

Due to the progressive nature of cervical spondylotic myelopathy, consistent evaluation of patient histories, the identification of functional impairment, and radiographic evidence of cervical spine stenosis and spinal cord compression require due diligence.

K. Daniel Riew, MD, is an internationally respected spinal surgeon. Regarding spinal manipulation of the cervical spine, Dr. Riew is quoted as follows [2],

“Most patients can receive spinal manipulation. If they have severe spinal cord compression, then I do not recommend it. However, I have seen thousands of patients who have undergone chiropractic spinal manipulation and I can count on one hand the number of patients who have been harmed by it – there are many more patients who have been harmed by bad spinal operations.”

Chiropractic physicians must critically assess complex signs of neurodegeneration and determine whether patients may benefit from chiropractic care and/or neurosurgical intervention.

Reference

2. Riew KD. Managing cervical spondylotic myelopathy. Spinal News International: Issue 24, July 2012.

Disclaimer

The views and opinions expressed in this presentation are solely those of the author. We offer this only to educate and inform.

PostGradDC offers advanced post-graduate chiropractic continuing education. Our founder, Dr. James Demetrious, is an internationally distinguished board-certified chiropractic orthopedist, educator, author, and editor. For current, evidence-based, and clinically intuitive CE Coursework, attain your advanced training at PostGradDC.com.