Vascular factors in the my elopathy associated with cervical spondylosis

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Abstract
The spinal cord in patients with cervical spondylosis is usually found at operation not to be compressed. The neurological level frequently does not correspond to the level of radiological changes. This suggests that cervical myelopathy is caused not by direct cord compression but by vascular insufficiency. A comparison of spinal cord syndromes known to be ischemic and the clinical syndromes of cervical myelopathy shows them to be substantially similar. The blood supply of the cervical spinal cord is such that the lesions found in cervical myelopathy can be caused by compression of the important radicular arteries entering at the cervical 5/6/7 level. Findings at operation and histological examination of the tissue surrounding the vertebral artery and spinal roots show that these important arteries can be compressed in the narrowed foramina and fibrous perineural root sleeves. It follows that surgical treatment of this disorder should be not laminectomy alone but laminectomy combined with decompression of the cervical nerve roots found at operation to be compressed. Fifteen patients have been operated on in this manner with early results superior to those obtained by simple laminectomy or conservative treatment.