Studies in cervical spondylotic myelopathy. II. The movement and contour of the spine in relation to the neural complications of cervical spondylosis. Brain

THERE is little room for complacency when considering the neural complications of cervical spondylosis. Their diagnosis is often by exclusion and variations in the natural history are difficult to explain. Often the neurological features bear little relation to the severity of the spondylosis, while the surgical treatment often confers less benefit than might be expected if compression of the spinal cord by osteophytes is all-important. The authors find it curious, however, that either immobilizing the neck with a collar or decompressing the spinal canal by operation may produce improvement in spondylotic myelopathy. This paper reports the results of investi-gations into the mobility and contour of the cervical spine in patients with cervical spondylosis and its complications. It is considered that these studies go some way in elucidating some of the problems enumerated above. Only movement of the head and neck in the sagittal plane has been investigated but this combines a change of contour and range of movement not seen in any other direction. Also such measure-ments can be accurately made from radiographs of the neck in full flexion and extension. METHOD Three groups of patients were investigated: Group I.—A control group of patients without symptoms or signs related to cervical radiculo-pathy or myelopathy. Group II.—Patients with cervical spondylotic radiculopathy without evidence of cord damage. Group HI.—Patients with cervical spondylotic myelopathy with or without signs of radiculopathy. Group I.—This group consisted of 48 patients who attended outpatients at the National Hospital for Nervous Diseases and had their necks X-rayed on request of the examining doctor. This number was derived from a larger group; some patients were eliminated either because the radio-graphs were unsuitable for tracing or had not been taken with the standard technique (72 in. tube-film distance). Others were excluded because their symptoms and signs might possibly be explained by cervical spondylotic radiculopathy or myelopathy although the clinical features were by guest on