Five patients with severe cervical spondylotic myelopathy were followed clinically until their deaths, and their neurologic deficits were repeatedly documented. In the terminal phase, these patients exhibited abnormal postures, severe muscle wasting, and the inability to stand and walk. Sensory loss varied and was most severe peripherally. Necropsy on all 5 patients disclosed multiple levels of spinal cord compression as measured by computing an anteroposterior compression ratio. This compression was associated with extrusive destruction of both gray and white matter, and ascending and descending demyelination could be traced above and below the most damaged segment.