by B. Hilton
Cervical spondylotic myelopathy (CSM) can cause many recognised symptoms which are easy to associate as they allude to nerve-related problems: numb and clumsy fingers, trouble walking with loss of balance, pain in the neck and arms, and urinary and bowel dysfunction.
However, what about the less well recognised or associated problems? For example, difficulty sleeping, anxiety and depression, and especially headache. As the main treatment for CSM is surgery, the impact of an operation on the well-recognised symptoms is well known, although not entirely predictable and understood. However, we do not know how surgery on CSM in the neck can impact upon headaches caused by CSM. A team of researchers in Beijing, China took it upon themselves to investigate this .
What did they do?
The researchers examined 108 cases of patients with CSM who complained of headache. Each patient was then given an operation using one of three surgical techniques: anterior cervical discectomy and fusion (ACDF), total disc replacement (TDR), or laminoplasty. The patients were then re-assessed at 25 and 145 months after their operation. The team discovered that roughly 4 out of 5 patients (80%) found that the operation improved their headache, often even making it go away all together! The other 1 out of 5 patients (20%) did not get any benefit from the surgery for their headache. However, it is of course possible that these patients’ headaches were not related to their CSM in the first place. The researchers also found that all three types of surgery showed the same improvement in headache; no approach was dramatically better than the other two.
So, what does this all mean?
Well, although surgery is not currently indicated for treatment of headache alone, relieving pressure on the spinal cord does seem to improve CSM-induced headache, which is promising news! Based on this single study, if you have a headache caused by CSM then you stand a good chance of seeing some improvement of this headache after an operation on your neck. Of course, more research is needed to confirm these findings, as this is almost a stand-alone project – however, it does signal some hope to those suffering from cervicogenic headaches!
 Sun et al. Effect of different surgical methods on headache associated with cervical spondylotic myelopathy and/or radiculopathy. BMJ Surgery. 2015; 15:105.
by B. Davies
If we took a hundred random individuals, over the age of 40 off the street, and performed a cervical MRI scan, as many as 56 would have imaging changes associated with myelopathy. However, fewer than 1 or 2 would actually have spinal cord injury and therefore actual myelopathy. These numbers may not be exact (although they were found in a recent study), but you get the gist. 
So a big question for researchers is what happens to the other 54 people…. Do they go on to get myelopathy? Is it just a question of time? Or will they remain unaffected?
There has only ever been one study looking at this by Joseph Bednarik. In that study they found that, given time, as many as 10 of the remaining 54 would get myelopathy .
In a follow up study published this month , Dr Bednarik has been looking at whether we can predict which of those 54 patients will develop myelopathy. They found that if a patient had had cervical radiculopathy, or electrophysiological signs of cord problems or more significant compression features on their MRI, they were more likely to develop myelopathy.
These findings need to be confirmed in larger studies, but they are interesting. For one, it suggests that features of cord injury (electrophysiology) come before any symptoms of myelopathy! We know that catching myelopathy early is important, but this is going to make things even more difficult!
1) Adamova, B., Kerkovsky, M., Kadanka, Z., Dusek, L., Jurova, B., Vlckova, E., & Bednarik, J. (2017). Predictors of symptomatic myelopathy in degenerative cervical spinal cord compression. Brain and Behavior, 7(9), e00797.
2) Bednarik, J., Kadanka, Z., Dusek, L., Kerkovsky, M., Vohanka, S., Novotny, O., et al. (2008). Presymptomatic spondylotic cervical myelopathy: an updated predictive model. European Spine Journal : Official Publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society, 17(3), 421–431.
3) Kovalova, I., Kerkovsky, M., Kadanka, Z., Nemec, M., Jurova, B., Dusek, L., et al. (2016). Prevalence and Imaging Characteristics of Non-Myelopathic and Myelopathic Spondylotic Cervical Cord Compression. Spine.
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