Cervical Spondylotic Myelopathy – Presentation and Natural History

Presenting Symptoms

Gait disturbance is observed in 100 % of patients with cervical spondylotic myelopathy (CSM) in longitudinal cohort studies, making it the most universal presenting sign. 1
Impaired hand dexterity occurs in ≈ 72 % of CSM patients, manifesting as difficulty with fine‑motor tasks such as buttoning or writing. 1
Upper‑extremity weakness is reported in ≈ 45 % of CSM patients, typically affecting distal muscle groups more than proximal ones. 1

A stepwise decline with intermittent quiescent periods characterizes ≈ 75 % of CSM cases; new neurological deficits appear episodically rather than continuously. 2, 3, 4
A slow, steady progression without stepwise fluctuations occurs in ≈ 20 % of patients. 2
A rapid onset followed by a prolonged plateau is seen in ≈ 5 % of cases. 2

Across most series, the average time from symptom onset to diagnosis ranges from 1 to 2 years. 2, 1