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Cervical spondylotic myelopathy
Volume 16, Number 4
December 2004
Introduction Cervical Spondylotic Myelopathy
I
n the following articles, cervical spondylotic myelopathy (CSM) will be discussed in a manner that should be approachable by neophytes and should be useful to experienced surgeons in the field. The authors have been instructed to concisely review the critical historical articles and also to provide the most up to date information on concepts and current practice. The aim of these series of reviews was not to generate another comprehensive review of the literature but rather to allow for experts in the field to use their personal experiences and opinions to color and add to their review of the literature. The diagnosis of CSM is based on a triad of historical, physical, and imaging findings. Each of these three factors is discussed individually in the following articles. The history and physical exam findings and their usefulness are discussed by Drs. Rumi and Yoon. Imaging findings have become more complex due to the availability of multiple different imaging modalities including X-ray, myelogram, CT, CTmyelogram, and MRI. Their usefulness in making the diagnosis and predicting outcome are discussed by Dr. Park. Because the presentation of CSM can be varied, ranging from the subtle to the most obvious, it is important to understand
1040-7383/04/$-see front matter © 2004 Elsevier Inc. All rights reserved. doi:10.1053/j.semss.2004.11.001
the differential diagnosis of CSM. Therefore, a separate article has been devoted to this topic and is presented by Drs. Vigna and Tortollani. The topic of natural history of CSM is of critical importance in understanding the rational for early surgical intervention. The seminal natural history articles will be discussed and placed in the context of the more recent data by Drs. Murray and Tay. Surgical treatment can involve anterior only (Dr. Singh and Dr. An), posterior only (Dr. Rhee), or combined anterior and posterior approaches (Drs. Riew and Glattes). The indications for each of these approaches and surgical techniques are reviewed. The authors have been encouraged to describe their person preferences and add technical pearls in their articles. A relatively under-recognized complication of anterior cervical surgery is dysphagia and dysphonia. By inviting an otolaryngologist (Dr. Johns) and an elder statesman of spine surgery (Dr. Whitesides) to write on this topic, we provide a fresh perspective that add depth to our understanding of this topic. S. Tim Yoon, MD, PhD Guest Editor
221
December 2004
Introduction Cervical Spondylotic Myelopathy
I
n the following articles, cervical spondylotic myelopathy (CSM) will be discussed in a manner that should be approachable by neophytes and should be useful to experienced surgeons in the field. The authors have been instructed to concisely review the critical historical articles and also to provide the most up to date information on concepts and current practice. The aim of these series of reviews was not to generate another comprehensive review of the literature but rather to allow for experts in the field to use their personal experiences and opinions to color and add to their review of the literature. The diagnosis of CSM is based on a triad of historical, physical, and imaging findings. Each of these three factors is discussed individually in the following articles. The history and physical exam findings and their usefulness are discussed by Drs. Rumi and Yoon. Imaging findings have become more complex due to the availability of multiple different imaging modalities including X-ray, myelogram, CT, CTmyelogram, and MRI. Their usefulness in making the diagnosis and predicting outcome are discussed by Dr. Park. Because the presentation of CSM can be varied, ranging from the subtle to the most obvious, it is important to understand
1040-7383/04/$-see front matter © 2004 Elsevier Inc. All rights reserved. doi:10.1053/j.semss.2004.11.001
the differential diagnosis of CSM. Therefore, a separate article has been devoted to this topic and is presented by Drs. Vigna and Tortollani. The topic of natural history of CSM is of critical importance in understanding the rational for early surgical intervention. The seminal natural history articles will be discussed and placed in the context of the more recent data by Drs. Murray and Tay. Surgical treatment can involve anterior only (Dr. Singh and Dr. An), posterior only (Dr. Rhee), or combined anterior and posterior approaches (Drs. Riew and Glattes). The indications for each of these approaches and surgical techniques are reviewed. The authors have been encouraged to describe their person preferences and add technical pearls in their articles. A relatively under-recognized complication of anterior cervical surgery is dysphagia and dysphonia. By inviting an otolaryngologist (Dr. Johns) and an elder statesman of spine surgery (Dr. Whitesides) to write on this topic, we provide a fresh perspective that add depth to our understanding of this topic. S. Tim Yoon, MD, PhD Guest Editor
221