Cervical myelopathy

Last updated: January 24, 2023

Summarytoggle arrow icon

Cervical myelopathy is a type of myelopathy that is caused by axonal injury of the cervical spinal cord, either by direct compression or ischemic injury due to compression of the anterior spinal artery. The most common cause is cervical spondylotic myelopathy. Other etiologies include spinal trauma, neoplasms, epidural abscess, and autoimmune disorders. Onset can be acute, insidious, or progress in a stepwise fashion. Clinical features include neck pain and stiffness, impaired sensation in the hands and arms, weakness, poor manual dexterity, and gait instability. The diagnosis is confirmed by MRI. Treatment includes conservative management for mild disease without functional impairment or surgical decompression in acute or severe disease with functional impairment.

Etiologytoggle arrow icon


Pathophysiologytoggle arrow icon

  • Cervical myelopathy is characterized by axonal injury in the cervical spinal cord due to:


Clinical featurestoggle arrow icon

Clinical features depend on the level of compression. Symptoms may be acute in onset (e.g., with trauma) or progress slowly (e.g., degenerative diseases) or in a step-wise fashion.

Injury to the spinal cord and the nerve roots (radiculopathy) often occurs simultaneously!

Pain is often absent in early stages. Therefore, a high index of suspicion is needed to make an early diagnosis and prevent progression of functional impairment due to spinal cord injury!


Diagnosticstoggle arrow icon


Differential diagnosestoggle arrow icon


The differential diagnoses listed here are not exhaustive.

Treatmenttoggle arrow icon

Acute cervical myelopathy with loss of bladder and bowel control is a neurological emergency that demands immediate surgical decompression!


Referencestoggle arrow icon

  1. Focus On: Cervical Myelopathy. Updated: January 1, 2012. Accessed: June 12, 2018.
  2. Cervical Myelopathy. . Accessed: June 12, 2018.
  3. Baron EM, Young WF. Cervical spondylotic myelopathy. Neurosurgery. 2007; 60 (suppl_1): p.S1-35-S1-41.doi: 10.1227/01.neu.0000215383.64386.82 . | Open in Read by QxMD
  4. Agabegi SS, Agabegi ED. Step-Up To Medicine. Wolters Kluwer Health ; 2015
  5. Levin, K.. Cervical spondylotic myelopathy. In: Post TW, ed. UpToDate. Waltham, MA: UpToDate. Last updated: February 5, 2019. Accessed: February 27, 2019.
  6. Ford B. MKSAP 16: Neurology. American College of Physicians ; 2012

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