Degenerative cervical spinal stenosis: current strategies in diagnosis and treatment.

INTRODUCTION Cervical spinal stenosis has become more common because of the aging of the population. There remains much uncertainty about the options for surgical treatment and their indications, particularly in cases of cervical myelopathy. METHODS In order to provide guidance in clinical decision-making, the authors selectively reviewed the literature, according to the guidelines of the Association of Scientific Medical Societies in Germany. RESULTS Cervical myelopathy is a clinical syndrome due to dysfunction of the spinal cord. Its most common cause is spinal cord compression by spondylosis at one or more levels. Its spontaneous clinical course is variable; most patients undergo a slow functional deterioration. Surgical treatment reliably arrests the progression of myelopathy and often even improves the neurological deficits. DISCUSSION The available scientific data are too sparse to enable evidence-based treatment of cervical myelopathy. Early surgical intervention is often recommended in the literature. Controversy remains regarding the choice of the appropriate surgical procedure, but there is consensus on the suitable options for many specific clinical situations.