SRS, Stereotactic radiosurgery; WBRT, Whole-brain radiation therapy
CSM, Cervical spondylotic myelopathy
Cervical spondylotic myelopathy (CSM) is the most common cause of spinal cord dysfunction in the elderly 5-R-Rivaroxaban
(9). It is also considered “the most common cause of nontraumatic spastic paraparesis and quadriparesis” (1). The pathophysiology of CSM is thought to begin with degeneration of the intervertebral disk, which leads to disc bulging, and increased mechanical stress at the end plates of adjacent vertebral bodies 1 and 7. CSM usually occurs as a result of canal narrowing, dynamic factors (damage that may occur during neck flexion/extension), and spinal cord ischemia (1). Typically, myelopathy develops when patients have >30% caliber reduction in the cross-sectional area of the cervical canal (10).
CSM is clinically characterized by signs of spinal cord compression
(i.e., long-tract signs) (5). The most common symptoms are leg stiffness/weakness and gait abnormalities. Patients usually complain of a feeling or imbalance when walking (1). CSM may also present as loss of manual dexterity, numbness in the hands, difficulty opening doorknobs or jars, trouble buttoning a shirt, hand weakness, and others. Long-tract signs occur due to “inhibition of the spinal afferent or efferent (pyramidal) nerve tracts” (5). These signs include hyperreflexia of the upper and lower extremities, clonus, increased muscle tone, and the presence of pathologic reflexes such as Hoffman sign and Babinski sign.