Materiały źródłowe

• #1 (PDF) Overview of Cervical Spondylosis Pathophysiology and Biomechanics

  https://www.academia.edu/17558462/Overview_of_Cervical_Spondylosis_Pathophysiology_and_Biomechanics

  C ervical spondylosis is the defined as „spinal canal and neural foraminal narrowing in cervical spine secondary to multifactorial degenerative changes”. This is one of the most common degenerative disorders of the spine, affecting 95% of patients by the age of 65 years. The degeneration of the intervertebral disc stems from osteophyte development of the amphiarthrodial joint, contrasting with arthritis, which is associated with diarthrodial joints and synovial space. The non-inflammatory disc degeneration is one of the defining characteristics of spondylosis. […] The degenerative changes of the cervical spine are responsible for the primary lesions in cervical spondylosis, while both spinal cord (neural) and vascular compression are responsible for the myelopathic symptoms. […] These early changes ultimately lead to the main pathophysiological process of cervical spondylosis, a reduction in sagittal spinal canal diameter.

• #2 Cervical spondylosis | PPT

  https://www.slideshare.net/slideshow/cervical-spondylosis-58045562/58045562

  Cervical Spondylotic Myelopathy (CSM) was first described by Brain et al in 1952. A common condition. Estimated to account for 2% of all hospital admissions. Most frequent cause of spinal cord dysfunction in patients older than 55 years. On the basis of radiologic findings, 90% of men older than 50 years and 90% of women older than 60 years have evidence of degenerative changes in the cervical spine. […] A degenerative disease of the cervical spine, intervertebral discs, ligaments and cartilaginous material. Commonly seen in individuals after the age of 40 years. Believed to be part of the normal aging process of the vertebral column. Some authors also include the degenerative changes in the facet joints, longitudinal ligaments, and ligamentum flavum. Spondylosis progresses with age and often develops at multiple interspaces. Chronic cervical degeneration – most common cause of progressive spinal cord and nerve root compression. Spondylotic changes can result in stenosis of spinal canal leading to Myelopathy. lateral recess and foramina leading to Radiculopathy.

• #3 The pathogenesis of cervical spondylosis – PubMed

  https://pubmed.ncbi.nlm.nih.gov/2536306/

  Cervical spondylosis is a generalized disease process affecting all levels of the cervical spine. Cervical spondylosis encompasses a sequence of degenerative changes in the intervertebral discs, osteophytosis of the vertebral bodies, hypertrophy of the facets and laminal arches, and ligamentous and segmental instability. The natural history of cervical spondylosis is associated with the aging process. Senescent and pathologic processes are thus morphologically indistinguishable. Clinical manifestations of cervical spondylosis may arise when morphologic sequelae are superimposed on a developmentally narrow spinal canal. The two clinical syndromes of spondylotic radiculopathy and myelopathy are distinct, yet they may overlap.

• #4

  https://journals.lww.com/clinorthop/abstract/1989/02000/the_pathogenesis_of_cervical_spondylosis.9.aspx

  Cervical spondylosis is a generalized disease process affecting all levels of the cervical spine. Cervical spondylosis encompasses a sequence of degenerative changes in the intervertebral discs, osteophytosis of the vertebral bodies, hypertrophy of the facets and lamina1 arches, and ligamentous and segmental instability. […] The natural history of cervical spondylosis is associated with the aging process. Senescent and pathologic processes are thus morphologically indistinguishable. Clinical manifestations of cervical spondylosis may arise when morphologic sequelae are superimposed on a developmentally narrow spinal canal. The two clinical syndromes of spondylotic radiculopathy and myelopathy are distinct, yet they may overlap.

• #5 Cervical Spondylosis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK551557/

  Cervical spondylosis is a natural age-related disease process that is associated with degenerative changes within the intervertebral disc. […] The primary risk factor and contributor to the incidence of cervical spondylosis is age-related degeneration of the intervertebral disc and cervical spinal elements. Degenerative changes in surrounding structures, including the uncovertebral joints, facets joints, posterior longitudinal ligament (PLL), and ligamentum flavum all combine to cause narrowing of the spinal canal and intervertebral foramina. Consequently, the spinal cord, spinal vasculature, and nerve roots can be compressed, resulting in the three clinical syndromes in which cervical spondylosis presents: axial neck pain, cervical myelopathy, and cervical radiculopathy. […] The pathogenesis of cervical spondylosis involves a degenerative cascade that produces biomechanical changes in the cervical spine, manifesting as secondary compression of neural and vascular structures. An increase in the keratin-chondroitin ratio prompts changes to the proteoglycan matrix resulting in loss of water, protein, and mucopolysaccharides within the intervertebral disc. Desiccation of the disc causes the nucleus pulposus to lose its elasticity as it shrinks and becomes more fibrous. As the nucleus pulposus loses its ability to maintain weight-bearing loads effectively, it begins to herniate through the fibers of the annulus fibrosus and contributes to the loss of disc height, ligamentous laxity, and buckling, and compression of the cervical spine. With further disc desiccation, the annular fibers become more mechanically compromised under compressive loads, producing significant alterations in the load distribution along the cervical spine. The result is a reversal of the normal cervical lordosis. Progression of the kyphosis causes the annular and Sharpeys fibers to peel off from the vertebral body edges, resulting in reactive bone formation. These bone spurs or osteophytes can form along the ventral or dorsal margins of the cervical spine, which can then project into the spinal canal and intervertebral foramina. Furthermore, disruption in the load balance along the spinal column generates greater axial loads onto the uncovertebral and facet joints which triggers hypertrophy or enlargement of the joints and accelerates bony spur formation into the surrounding neural foramen. These degenerative changes lead to loss of cervical lordosis and movement, as well as a reduction in the spinal canal diameter.

• #6 Cervical Spondylosis: Pathophysiology, Natural History, and Clinical Syndromes of Neck Pain, Radiculopathy, and Myelopathy | Musculoskeletal Key

  https://musculoskeletalkey.com/cervical-spondylosis-pathophysiology-natural-history-and-clinical-syndromes-of-neck-pain-radiculopathy-and-myelopathy/

  Degenerative changes at the cervical discs and facet joints are ubiquitous in the adult population; these changes are a natural consequence of aging and are asymptomatic in most of the population. Spondylosis refers to these age-related degenerative changes within the spinal column. […] Although most of these age-related degenerative changes remain asymptomatic, they can manifest as three main symptom complexesaxial neck pain, upper extremity radiculopathy, or myelopathyor some combination thereof. […] Degenerative changes within the cervical disc lead to loss of disc height, arthrosis in the uncovertebral and facet joints, and motion aberrations between two vertebral bodies. […] In most patients, desiccation of the disc initiates a cascade of degenerative changes. […] An alteration in proteoglycan content beginning in the 3rd decade diminishes the ability of the disc to maintain its hydration.

• #7 Cervical Spondylosis: Pathophysiology, Natural History, and Clinical Syndromes of Neck Pain, Radiculopathy, and Myelopathy | Musculoskeletal Key

  https://musculoskeletalkey.com/cervical-spondylosis-pathophysiology-natural-history-and-clinical-syndromes-of-neck-pain-radiculopathy-and-myelopathy/

  The amount of keratin sulfate increases, and the amount of chondroitin sulfate decreases. […] With these changes in viscoelasticity, the periphery of the disc begins to bear an increasingly greater proportion of the load borne by the disc, with resultant loss of disc height and bulging of the anulus into the spinal canal. […] As the disc loses height, the vertebral bodies approach each other, causing infolding of the ligamentum flavum and facet joint capsule and reducing the dimensions of the canal and the foramen. […] A positive feedback cycle ensues with greater force placed on the ventral aspect of the vertebral bodies leading to kyphosis. […] The uncovertebral and facet joints bear greater loads, accelerating the formation of osteophytes at these joints and at the peripheral vertebral endplate margins.

• #8 Cervical Spondylosis: Pathophysiology, Natural History, and Clinical Syndromes of Neck Pain, Radiculopathy, and Myelopathy | Clinical Gate

  https://clinicalgate.com/cervical-spondylosis-pathophysiology-natural-history-and-clinical-syndromes-of-neck-pain-radiculopathy-and-myelopathy/

  Degenerative changes at the cervical discs and facet joints are ubiquitous in the adult population; these changes are a natural consequence of aging and are asymptomatic in most of the population. Spondylosis refers to these age-related degenerative changes within the spinal column. Most patients who present with cervical spondylosis are older than 40 years. Although most of these age-related degenerative changes remain asymptomatic, they can manifest as three main symptom complexesaxial neck pain, upper extremity radiculopathy, or myelopathyor some combination thereof. […] This chapter reviews the anatomy, pathogenesis, natural history, and relevant clinical features of patients with axial neck pain, radiculopathy, and myelopathy. […] Degenerative changes within the cervical disc lead to loss of disc height, arthrosis in the uncovertebral and facet joints, and motion aberrations between two vertebral bodies. In most patients, desiccation of the disc initiates a cascade of degenerative changes. An alteration in proteoglycan content beginning in the 3rd decade diminishes the ability of the disc to maintain its hydration. The amount of keratin sulfate increases, and the amount of chondroitin sulfate decreases. With these changes in viscoelasticity, the periphery of the disc begins to bear an increasingly greater proportion of the load borne by the disc, with resultant loss of disc height and bulging of the anulus into the spinal canal. […] As the disc loses height, the vertebral bodies approach each other, causing infolding of the ligamentum flavum and facet joint capsule and reducing the dimensions of the canal and the foramen. A positive feedback cycle ensues with greater force placed on the ventral aspect of the vertebral bodies leading to kyphosis. The uncovertebral and facet joints bear greater loads, accelerating the formation of osteophytes at these joints and at the peripheral vertebral endplate margins. Osteophytes, the posteriorly protruded disc material, and the infolded soft tissue within the canal and neuroforamina all diminish the space available for the spinal cord or nerve root.

• #9 Cervical Spondylosis: Practice Essentials, Pathophysiology, Epidemiology

  https://emedicine.medscape.com/article/1144952-overview

  Cervical spondylosis is a chronic degenerative condition of the cervical spine that affects the vertebral bodies and intervertebral disks of the neck (in the form of, for example, disk herniation and spur formation), as well as the contents of the spinal canal (nerve roots and/or spinal cord). Some authors also include the degenerative changes in the facet joints, longitudinal ligaments, and ligamentum flavum. […] Spondylosis progresses with age and often develops at multiple interspaces. Chronic cervical degeneration is the most common cause of progressive spinal cord and nerve root compression. Spondylotic changes can result in stenosis of the spinal canal, lateral recess, and foramina. Spinal canal stenosis can lead to myelopathy, […] Intervertebral disks lose hydration and elasticity with age, and these losses lead to cracks and fissures. The surrounding ligaments also lose their elastic properties and develop traction spurs. The disk subsequently collapses as a result of biomechanical incompetence, causing the annulus to bulge outward. As the disk space narrows, the annulus bulges, and the facets override. This change, in turn, increases motion at that spinal segment and further hastens the damage to the disk. Annulus fissures and herniation may occur. Acute disk herniation may complicate chronic spondylotic changes.

• #10 Cervical spondylosis | PPT

  https://www.slideshare.net/slideshow/cervical-spondylosis-58045562/58045562

  Studies involving radiological investigation of asymptomatic individuals show that spondylotic changes increase with each decade of life: 5-10% by the age of 20-30 years 50% by age 45 years, and 90% by 60 years of age. […] The course of cervical spondylosis may be slow and prolonged. May either remain asymptomatic or have mild cervical pain. Long periods of nonprogressive disability are typical. […] PATHOPHYSIOLOGY Intervertebral discs lose hydration and elasticity with age – leading to cracks and fissures. The surrounding ligaments also lose their elastic properties and develop traction spurs. The disk subsequently collapses as a result of biomechanical incompetence, causing the annulus to bulge outward. […] As disk degeneration occurs, the uncinate process overrides and hypertrophies, compromising the ventrolateral portion of the foramen. Likewise, facet hypertrophy decreases the dorsolateral aspect of the foramen. This change contributes to the radiculopathy that is associated with cervical spondylosis. Marginal osteophytes begin to develop.

• #11 Cervical Spondylosis: Pathophysiology, Natural History, and Clinical Syndromes of Neck Pain, Radiculopathy, and Myelopathy | Musculoskeletal Key

  https://musculoskeletalkey.com/cervical-spondylosis-pathophysiology-natural-history-and-clinical-syndromes-of-neck-pain-radiculopathy-and-myelopathy/

  Osteophytes, the posteriorly protruded disc material, and the infolded soft tissue within the canal and neuroforamina all diminish the space available for the spinal cord or nerve root. […] Cervical spondylotic myelopathy is the development of long tract signs as a result of degenerative changes at the cervical spinal motion segment. […] Cervical discs and facet joints can generate pain. […] Nerve fibers and nerve endings, containing somatic afferent fibers, innervate the peripheral portion of the intervertebral disc (the outer third of the anulus) and offer a potential mechanism by which degenerative cervical discs generate pain directly. […] The presence of mechanoreceptors and nociceptive nerve endings in cervical facet joint capsules further supports a possible role for these structures in the pathogenesis of cervical spine pain.

• #12 Spondylosis | Degenerative, Cervical & Lumbar | Britannica

  https://www.britannica.com/science/spondylosis

  spondylosis, noninflammatory degenerative disease of the spine resulting in abnormal bone development around the vertebrae and reduced mobility of the intervertebral joints. […] Spondylosis involves both excessive growth of bone and reactive osteoarthritis. The narrowing of the intervertebral spaces by the former process produces symptoms by compressing nerves that emerge from the spinal cord; these symptoms are worsened when arthritic bone growth further narrows the spinal canal. Eventual fusion of the intervertebral joints results when connecting ligaments are replaced with bone or when osteoarthritic bony spurs unite.

• #13 Cervical Spondylosis: Practice Essentials, Pathophysiology, Epidemiology

  https://emedicine.medscape.com/article/1144952-overview

  As disk degeneration occurs, the uncinate process overrides and hypertrophies, compromising the ventrolateral portion of the foramen. Likewise, facet hypertrophy decreases the dorsolateral aspect of the foramen. This change contributes to the radiculopathy that is associated with cervical spondylosis. Marginal osteophytes begin to develop. Additional stresses, such as trauma or long-term heavy use, may exacerbate this process. These osteophytes stabilize the vertebral bodies adjacent to the level of the degenerating disk and increase the weight-bearing surface of the vertebral endplates. […] Degeneration of the joint surfaces and ligaments decreases motion and can act as a limiting mechanism against further deterioration. Thickening and ossification of the posterior longitudinal ligament (OPLL) also decreases the diameter of the canal.

• #14 Cervical spondylotic myelopathy – UpToDate

  https://www.uptodate.com/contents/cervical-spondylotic-myelopathy

  These processes can lead to narrowing of the central cervical canal (ie, cervical spinal stenosis). This in turn can produce dysfunction of the adjacent spinal cord, as the combined result of mechanical compression of neural elements and spinal cord ischemia due to compression of the arterial and/or venous blood supply to the cord. Flexion and extension of the neck may exacerbate compression; the canal diameter is reduced by 2 to 3 mm in flexion, while extension can cause inward buckling of the ligamentum flavum.

• #15 Cervical Spondylosis: Pathophysiology, Natural History, and Clinical Syndromes of Neck Pain, Radiculopathy, and Myelopathy | Clinical Gate

  https://clinicalgate.com/cervical-spondylosis-pathophysiology-natural-history-and-clinical-syndromes-of-neck-pain-radiculopathy-and-myelopathy/

  Although it is generally agreed that mechanical compression of the spinal cord is the primary pathophysiologic mechanism resulting in myelopathy, in many patients a combination of this static compression with dynamic factors secondary to motion between the vertebral bodies, a congenitally stenotic canal, changes in the intrinsic morphology of the spinal cord, and vascular factors contributes to the development of myelopathy. […] A developmentally narrow spinal canal in the anteroposterior plane can contribute to the development of cervical myelopathy. The normal anteroposterior diameter of the cervical spine measures 17 to 18 mm in adults, and the anteroposterior diameter of the spinal cord in the cervical region measures approximately 10 mm. An anteroposterior diameter of the spinal canal less than 13 mm defines congenital cervical stenosis, whereas a diameter greater than 16 mm suggests a relatively low risk of myelopathy. A strong association exists between flattening of the cord within the narrowed spinal canal and the development of cervical myelopathy.

• #16 Cervical Spondylotic Myelopathy: A Common Cause of Spinal Cord Dysfunction in Older Persons | AAFP

  https://www.aafp.org/pubs/afp/issues/2000/0901/p1064.html

  Spinal cord ischemia probably plays a role in the development of CSM, particularly in later stages. Histopathologic changes in the spinal cord consistent with ischemia have been observed in patients with CSM. However, the precise mechanism for spinal cord ischemia is not completely understood. Other factors associated with the development of spondylosis include heavy labor, posture and genetic predisposition.

• #17 Cervical Spondylosis: Practice Essentials, Pathophysiology, Epidemiology

  https://emedicine.medscape.com/article/1144952-overview

  The blood supply of the spinal cord is an important anatomic factor in the pathophysiology. Radicular arteries in the dural sleeves tolerate compression and repetitive minor trauma poorly. The spinal cord and canal size also are factors. A congenitally narrow canal does not necessarily predispose a person to myelopathy, but symptomatic disease rarely develops in individuals with a canal that is larger than 13 mm.

• #18 Cervical spondylosis | PPT

  https://www.slideshare.net/slideshow/cervical-spondylosis-58045562/58045562

  The blood supply of the spinal cord is an important anatomic factor in the pathophysiology. Radicular arteries in the dural sleeves tolerate compression and repetitive minor trauma poorly. […] Flexion of the cervical spine may lead to compression of the spinal cord against osteophytic bars while extension may lead to compression against the hypertrophied ligamentum avum. […] The narrowing of the spinal canal itself does not usually cause any symptoms. It is when inflammation of the nerves occurs at the level of increased pressure that patients begin to experience clinical problems.

• #19 ns :: Neurospine

  https://www.e-neurospine.org/m/journal/view.php?number=904

  The assessment, diagnosis, operative and nonoperative management of degenerative cervical myelopathy (DCM) have evolved rapidly over the last 20 years. A clearer understanding of the pathobiology of DCM has led to attempts to develop objective measurements of the severity of myelopathy, including technology such as multiparametric magnetic resonance imaging, biomarkers, and ancillary clinical testing. […] Study of the pathobiology of DCM has been limited in the past owing to lack of a robust animal model. However, the recent development of animal models that recreate the progressive spinal cord compression seen in humans have led to significant advances in our understanding of the pathobiological processes underpinning DCM, including ischemia, neuroinflammation, and apoptosis. […] The blood-spinal cord barrier (BSCB) is disrupted owing to loss and dysfunction of endothelial cells, which is further potentiated by ischemia. Disruption of the BSCB in DCM may be mediated by matrix metalloproteinase-9. With this disruption of the BSCB, there is an influx of inflammatory cells into the spinal cord parenchyma from the peripheral circulation; this initiates an inflammatory cascade characterized by activation of microglia and recruitment of macrophages.

• #20 Cervical Spondylotic Myelopathy: A Common Cause of Spinal Cord Dysfunction in Older Persons | AAFP

  https://www.aafp.org/pubs/afp/issues/2000/0901/p1064.html

  Cervical spondylotic myelopathy (CSM) is the most common cause of spinal cord dysfunction in older persons. […] Spondylosis refers to the degenerative changes that occur in the spine, including degeneration of the joints, intervertebral discs, ligaments and connective tissue of the cervical vertebrae. There are three important pathophysiologic factors in the development of CSM: (1) static mechanical; (2) dynamic mechanical; and (3) spinal cord ischemia. Static mechanical factors result in the reduction of spinal canal diameter and spinal cord compression. With aging, the intervertebral discs dry out resulting in loss of disc height. […] Osteophytic overgrowth ventrally and, in some cases, buckling of the ligamentum flavum dorsally can cause direct compression of the spinal cord resulting in myelopathy (clinically evident spinal cord dysfunction). Symptoms are believed to develop when the spinal cord has been reduced by at least 30 percent.

• #21 Cervical Spondylosis | Neupsy Key

  https://neupsykey.com/cervical-spondylosis/

  As the disc weakens, surrounding structures are required to bear a greater burden of weight-bearing load and dynamic stresses. […] Cervical spondylotic changes can lead to spinal canal and intervertebral foramen narrowing that can impinge on the spinal cord centrally or on the exiting nerve roots laterally. […] Pathologic changes found in CSM are due to factors that are often divided into static, dynamic, and vascular processes. […] Dynamic movement in cervical spondylosis may further lead to CSM. […] An MRI flexion-extension study by Muhle et al. demonstrated increasing spinal stenosis on average during extension compared to flexion. […] Some authors hypothesize that this occurs because spinal cord compression leads to ischemia at the microcirculation level. […] While cervical spondylotic changes are seen throughout the subaxial spine, involvement at C5-6 is the most common, followed by C6-7. […] Spinal cord compression symptoms may be exacerbated by the fact that C5-7 is a watershed area in the cervical cord, with reduced blood flow and greater potential for spinal cord ischemia.

• #22 Pathogenesis of cervical spondylotic myelopathy. | Journal of Neurology, Neurosurgery & Psychiatry

  https://jnnp.bmj.com/content/62/4/334

  OBJECTIVE: To determine whether either of two mechanical theories predicts the topographic pattern of neuropathology in cervical spondylotic myelopathy (CSM). The compression theory states that the spinal cord is compressed between a spondylotic bar anteriorly and the ligamenta flava posteriorly. The dentate tension theory states that the spinal cord is pulled laterally by the dentate ligaments, which are tensed by an anterior spondylotic bar. […] The predicted stress pattern of the dentate tension theory corresponds to the reported neuropathology, whereas the predicted stress pattern of the compression theory does not. […] The results strongly favour the theory that CSM is caused by tensile stresses transmitted to the spinal cord from the dura via the dentate ligaments. A spondylotic bar can increase dentate tension by displacing the spinal cord dorsally, while the dural attachments of the dentate, anchored by the dural root sleeves and dural ligaments, are displaced less. The spondylotic bar may also increase dentate tension by interfering locally with dural stretch during neck flexion, the resultant increase in dural stress being transmitted to the spinal cord via the dentate ligaments. Flexion of the neck increases dural tension and should be avoided in the conservative treatment of CSM. Both anterior and posterior extradural surgical operations can diminish dentate tension, which may explain their usefulness in CSM. The generality of these results must be tempered by the simplifying assumptions required for the mathematical model.

• #23 Cervical Spondylosis: Pathophysiology, Natural History, and Clinical Syndromes of Neck Pain, Radiculopathy, and Myelopathy | Musculoskeletal Key

  https://musculoskeletalkey.com/cervical-spondylosis-pathophysiology-natural-history-and-clinical-syndromes-of-neck-pain-radiculopathy-and-myelopathy/

  A strong association exists between flattening of the cord within the narrowed spinal canal and the development of cervical myelopathy. […] A developmentally narrow spinal canal in the anteroposterior plane can contribute to the development of cervical myelopathy. […] The normal anteroposterior diameter of the cervical spine measures 17 to 18 mm in adults, and the anteroposterior diameter of the spinal cord in the cervical region measures approximately 10 mm. […] A congenitally narrow spinal canal lowers the threshold at which the cumulative effects of various degenerative structures encroaching on the spinal cord cause signs and symptoms of myelopathy.

• #24 ns :: Neurospine

  https://www.e-neurospine.org/m/journal/view.php?number=904

  Ischemia, BSCB disruption, and neuroinflammation produce activation of apoptotic pathways resulting in progressive neuronal and oligodendroglial cell death. This apoptosis may be mediated by Fas, tumor necrosis factor-, and mitogen-activated protein kinase pathways. The role of glutamate excitotoxicity in DCM is akin to traumatic spinal cord injury. Specifically, there is an influx of Na+ owing to activation of neuronal voltage-gated Na+ channels. This leads to cytotoxic edema and an influx of Ca2+ through the Na+-Ca2+ exchange pump. This, in turn, triggers the release of glutamate into the extracellular space, causing an increase in local cell death through excitotoxic mechanisms.

• #25

  https://www.orthobullets.com/spine/2029/cervical-spondylosis

  Cervical Spondylosis represents the natural degenerative process of the cervical motion segment which can lead to cervical radiculopathy, cervical myelopathy, or axial neck pain. […] Spondylosis is a natural aging process of the spine characterized by degeneration of the disc and the four joints of the cervical motion segment which include two facet joints and two uncovertebral joints of Luschka. […] The degenerative cycle includes disc degeneration, joint degeneration, and ligamentous changes. […] Nerve root compression leads to the clinical condition of radiculopathy for foraminal spondylotic changes secondary to chondrosseous spurs of facet and uncovertebral joints. […] Central cord compression (central stenosis) leads to the clinical condition of myelopathy.

• #26 Cervical spondylotic myelopathy – UpToDate

  https://www.uptodate.com/contents/cervical-spondylotic-myelopathy

  Cervical spondylosis refers to a progressive degenerative process affecting the cervical vertebral bodies and intervertebral discs. This process can lead to narrowing (stenosis) of the central spinal canal (ie, cervical spinal stenosis). If sufficiently severe, the cervical spinal cord is compressed, producing a syndrome of spinal cord dysfunction known as cervical spondylotic myelopathy. Myelopathy occurs in 5 to 10 percent of patients with symptomatic cervical spondylosis. Other clinical syndromes associated with cervical spondylosis include neck pain and cervical radiculopathy. […] Cervical spondylosis is a general term for nonspecific, degenerative changes of the cervical spine that are common in older adults. These changes include degeneration of the intervertebral discs resulting in disc herniation; facet, uncovertebral, and vertebral body osteophyte formation; and ossification and hypertrophy of the posterior longitudinal ligament and ligamenta flava. The pathogenesis of cervical spondylosis is discussed separately.

• #27 Brain function specific alterations in young cervical spondylosis pati | JPR

  https://www.dovepress.com/functional-brain-changes-in-younger-population-of-cervical-spondylosis-peer-reviewed-fulltext-article-JPR

  Cervical spondylosis is a common chronic degenerative musculoskeletal disease, which is based on cervical intervertebral disc degeneration and secondary pathological changes involving the surrounding soft tissues, nerve roots, vertebral arteries, sympathetic nerves, and spinal cord. […] The generation and inhibition mechanism of chronic neck pain in cervical spondylosis is complex, involving multi-level, multi-pathway, and multi-substance regulatory mechanisms at the peripheral-spinal cord-brain level, especially the central regulatory mechanism of the brain, which is still unclear. […] Studies in the literature have shown a remodeling of both the structure and function of their brain in individuals with chronic pain due to prolonged and abnormal neural signaling afferents, information integration, and motor signaling efferents to the center.

• #28 Brain function specific alterations in young cervical spondylosis pati | JPR

  https://www.dovepress.com/functional-brain-changes-in-younger-population-of-cervical-spondylosis-peer-reviewed-fulltext-article-JPR

  The above results in the literature suggest the presence of alterations with CNP in both the structure and function of brain, which may be correlated with sensory, motor, emotional, and cognitive dysfunctions; however, the specific brain networks related to CNP are still unknown, and the spontaneous neuronal activity of brain regions in patients with CNP in the resting state has not yet gained much attention. […] This study showed that, compared with the healthy population, the increased ALFF values of young cervical spondylosis CNP patients were concentrated in the insula, cingulate gyrus, and prefrontal lobes. The decreased ALFF values were concentrated in the occipital and parietal lobes. […] It suggests young CNP patients have altered functional activity in multiple cortical brain regions involved in chronic pain-related sensations, emotions, and cognition.

• #29 Brain function specific alterations in young cervical spondylosis pati | JPR

  https://www.dovepress.com/functional-brain-changes-in-younger-population-of-cervical-spondylosis-peer-reviewed-fulltext-article-JPR

  The cingulate gyrus plays a crucial role within the SN network and is divided into the anterior cingulate gyrus (ACC) and posterior cingulate gyrus (PCC). […] Thus, it is clear that increased ALFF in the ACC may be one of the critical features of CNP, suggesting that, compared with the healthy population, the ACC of patients with CNP receives more negative pain emotions, and the more they develop adverse emotions and negative interpretations of pain. […] The occipital cortex is responsible for the integration of the hearing, vision, and somatosensory systems. […] In addition to the fact that most of the occipital cortex shows reduced spontaneous activity in patients with CNP, parts of the parietal lobe, particularly the back part of the parietal cortex, which is known for its function in spatial perception and body position perception, work in conjunction with the somatosensory cortex to help the brain integrate, localize, and interpret pain signals, reflecting dysfunction in body perception and pain localization in patients with chronic neck pain in comparison to a group of healthy subjects.

• #30 Cervical Spondylosis Types | Causes | Treatment | Alleviate Pain Clinic

  https://www.alleviatepainclinic.com/blog/what-is-cervical-spondylosis-anatomy-etiopathogenesis-types-and-treatment/

  Facet Joint Arthritis: Facet joints, located at the back of the spine, can undergo degeneration and arthritis. Inflammation and pain can result from facet joint dysfunction. […] Ligament Thickening: Ligaments in the cervical spine may thicken and stiffen, reducing neck mobility and potentially contributing to symptoms. […] Spinal Stenosis: The narrowing of the spinal canal, known as spinal stenosis, can occur with age, compressing the spinal cord and nerve roots. This condition is associated with myelopathy. […] Genetic Factors: Genetics can play a role in the development of cervical spondylosis. Some individuals may have a genetic predisposition to disc degeneration or other structural abnormalities. […] Occupational and Lifestyle Factors: Certain occupations or activities that involve repetitive neck movements or heavy lifting may increase the risk of cervical spondylosis. […] Smoking: Smoking has been linked to accelerated disc degeneration and may contribute to the development of cervical spondylosis. […] Trauma: Previous neck injuries or trauma, even if they occurred years earlier, can accelerate the degenerative process.

• #31 The incidence of cervical spondylosis decreases with aging in the elde | CIA

  https://www.dovepress.com/the-incidence-of-cervical-spondylosis-decreases-with-aging-in-the-elde-peer-reviewed-fulltext-article-CIA

  Cervical spondylosis is well accepted as a common degenerative change in the cervical spine. Compelling evidence has shown that the incidence of cervical spondylosis increases with age. […] Cervical spondylosis is a chronic degenerative process of the cervical spine that affects the vertebral bodies and intervertebral disks of the neck, and may progress into disk herniation, bone spur formation, compression of the spinal cord, or cervical spondylotic myelopathy. Cervical spondylosis often develops at multiple interspaces and worsens with age. […] Increasing clinical imaging data evidence that age is a risk factor and a contributor to the incidence of cervical spondylosis that increases with aging. […] The most age-related risk element with cervical spondylosis was hypertension, and to a lesser extent, hyperlipidemia, diabetes, cerebral infarct, cardiovascular diseases, smoking, and drinking.

• #32 The incidence of cervical spondylosis decreases with aging in the elde | CIA

  https://www.dovepress.com/the-incidence-of-cervical-spondylosis-decreases-with-aging-in-the-elde-peer-reviewed-fulltext-article-CIA

  Different from past reports that the incidence of cervical spondylosis increases with aging, the distinctive characteristics of this study have indicated that the incidence of cervical spondylosis increases with aging before age 50 years, and decreases with aging after age 50 years, especially in the elderly after 60 years. […] Increasing evidence shows that intervertebral disks lose hydration and elasticity with age, gradually resulting in cracks and fissures and causing a loss of their elastic properties for the surrounding ligaments and developing the onset of spurs. […] However, our clinical investigation has implicated that the incidence of cervical spondylosis decreases with aging in the elderly population, especially after 60 years, although it increases with aging before age 50 years.

• #33 The incidence of cervical spondylosis decreases with aging in the elde | CIA

  https://www.dovepress.com/the-incidence-of-cervical-spondylosis-decreases-with-aging-in-the-elde-peer-reviewed-fulltext-article-CIA

  Thus, we addressed the pathogenesis of cervical spondylosis and showed that the volume and inflammation of the nucleus gets lesser since chronic degeneration contributes to atrophy of the nucleus with the aging process. […] Considering that the inflammatory effect of the nucleus is stronger than degeneration in the young and the adults before 50 years, the highest incidence of cervical spondylosis corresponds with this age stage approximately 50 years. […] With the process of aging, the inflammatory effect of the nucleus is weaker than the degeneration of the nucleus after 60 years of age, the incidence of cervical spondylosis will decrease with aging.

• #34 Pathophysiology of cervical myelopathy (Review)

  https://www.spandidos-publications.com/10.3892/br.2023.1666

  The dynamic compression that occurs during the movements of the spine can cause cervical myelopathy. […] Spondylosis is widely considered a condition affecting middle-aged individuals; 95% of asymptomatic males and 70% of asymptomatic males by the age of 60-65 years have signs of degeneration in cervical radiography. […] The aging procedure affects the intervertebral disc and the surrounding cartilage formations. […] The sum of all age-related spine deformations affects not only the intervertebral disc, but also the joints of the spinal cord. […] The notion that ischemia contributes to the development of CSM is not a new one, but remains controversial. […] Spondylosis is a multi-factor cause of cervical myelopathy. […] A better understanding of the mechanism that drives to the formation of spondylotic changes will aid in the development of more effective treatment and preventive strategies.

• #35 Early versus late intervention for degenerative cervical myelopathy: what are the outcomes?—a review of the current literature – Connelly – AME Medical Journal

  https://amj.amegroups.org/article/view/9173/html

  Degenerative cervical myelopathy (DCM) is a condition resulting from chronic compression of the spinal cord in the cervical spine. […] The pathophysiology of DCM is related to both heritable and environmental contributions. Degenerative changes in the cervical spine occurring as a result of aging and repetitive stress cause structural changes in both the bone and soft tissues surrounding the spinal cord. […] Sources of mechanical compression on the cervical spine create microvascular compromise in the spinal cord resulting in ischemia and inflammation, ultimately leading to demyelination, axonal degeneration, and neuronal degradation. […] The progressive apoptotic loss of neuroglial cells and subsequent axonal degeneration is expressed as the progressive neurological deficits seen clinically with DCM. […] The literature suggests that early surgical intervention is essential to minimizing long-term disability and maximizing quality of life. […] Overall, the literature suggests that early surgical intervention is essential to minimizing long-term disability and maximizing quality of life.

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