Cervical spondylotic myelopathy (CSM) develops when age-related degenerative changes in the neck — disc thinning, bone spurs, thickened ligaments — progressively narrow the spinal canal enough to compress the spinal cord itself, not just a nerve root. It's the most common cause of spinal cord dysfunction in adults over 55, and it's frequently missed early because symptoms can be subtle and slow-moving.
Why this condition is different
Most neck problems we see are mechanical — joint, disc, or muscle-driven pain that responds well to manual therapy and exercise. CSM is not that. It involves the spinal cord, and untreated progression can lead to permanent neurological deficit. Recognizing the pattern early — and referring appropriately — matters more than any hands-on treatment we could offer.
Signs to take seriously
- Hand clumsiness — dropping objects, trouble with buttons or zippers, handwriting getting worse
- A subtly unsteady or wide-based gait, or new difficulty with balance
- Weakness that doesn't fit a single nerve root pattern
- Increased reflexes, or spasticity, in the arms or legs
- Numbness or tingling that is diffuse rather than following one nerve distribution
- Neck stiffness that may be relatively mild compared to the neurological symptoms
Notably, CSM often causes far more functional impairment than pain — patients sometimes have little to no neck pain at all, which is part of why it gets missed.
What we do
Any patient presenting with this symptom pattern gets a thorough neurological screen, including reflex testing and specific provocative signs. If findings are consistent with myelopathy, we refer promptly for imaging (MRI) and a spine specialist consultation — this is not a condition we attempt to manage with manipulation, and cervical manipulation is specifically avoided once myelopathy is suspected.
Treatment, in general terms
Mild, non-progressive cases may be monitored conservatively under specialist supervision. Moderate to severe or progressive cases typically require surgical decompression, which has good outcomes — especially when performed before significant deficit accumulates. This is exactly why early recognition matters so much.
Our role is to be the first line of screening: if something about your neck symptoms doesn't fit the usual mechanical pattern, tell us. Getting the diagnosis right, fast, is the priority.