Cervical Myelopathy 頸椎脊髓病變

頸椎有問題的病患，愈來愈常見。提早從生活上預防才是重要。
Cervical myelopathy refers to compression on the cervical spinal cord from either a disc herniation or cervical spinal stenosis. 
Generally, it is more common in the elderly population and is a slow process. Symptoms include incoordination in the hands, a heavy feeling in the legs, or numbness and tingling in the legs. It is generally a slowly progressive condition. It is usually not painful as compression of the spinal cord does not cause pain.

A clinical syndrome characterized by  (手腳都受影響，但不是以痛為主要表現)

• clumsiness in hands
• gait imbalance
• caused by compression of the spinal cord

寫得很好的英文資料: Cervical Myelopathy - Spine - Orthobullets.com http://goo.gl/2cVj9h
簡單中文摘要:
Cervical Spondylotic Myelopathy 的症狀和體徵 | Medisato 繁体中文 http://goo.gl/USCVyz
下肢痙攣性無力（spastic weakness of lower limbs）
治療方面:

• Nonoperative
  • observation, NSAIDs, therapy, and lifestyle modifications
    • indications
      • may be indicated in patient with no function impairment (but some physical exam finding consistent of myelopathy) 
      • patients who are not candidates for surgery
    • modalities
      • medications (NSAIDS, gabapentin)
      • immobilization (hard collar in slight flexion)
      • physical therapy for neck strengthening, balance, and gait training
      • traction and chiropractic modalities are not likely to benefit and do have some risks
      • be sure to watch patients carefully for progression
    • outcomes
      • improved nonoperative outcomes associated with patients with larger transverse area of the spinal cord (>70mm2) 
      • some studies have shown improvement with immobilization in patients with very mild symptoms
• Operative
  • surgical decompression and stabilization
    • indications
      • functional impairment due to myelopathy
      • asymptomatic patients with cord signal changes and radiographic compression is controversial
    • outcomes
      • prospective studies show improvement in overall pain, function, and neurologic symptoms with operative treatment
      • early recognition and treatment prior to spinal cord damage is critical for good clinical outcomes