Management for cervical myelopathy

Management of cervical myelopathy often requires urgent surgical decompression to prevent progressive and permanent neurological damage. Surgical decompression or stabilisation should be considered for those with significant functional impairment, instability or multilevel disease. Urgently refer all patients with suspected cervical myelopathy for neurosurgical assessment.

In people with little function impairment, or those who are poor surgical candidates, little evidence exists to guide management. However, a nonsurgical approach might be considered (after specialist assessment) for symptom controlNikolaidis, 2010. This may include considering the use of analgesics, such as paracetamol and NSAIDs. Physiotherapy should focus on balance, and gait training, and neck strengthening. Traction and manipulation are not recommended. Observation for progression of pathology should be undertaken.