• Indentation of the cervical part of the spinal cord by protrusion of intervertebral disks and by osteophytic lipping produces varied neurological symptoms directly by mechanical injury and indirectly by effects on the movement of blood and cerebrospinal fluid. Diagnosis depends on cerebrospinal fluid manometry and myelography, for the symptoms may have more than one cause.
In one case, the extensive paralyses in the patient were found to result from amyotrophic lateral sclerosis in addition to osteophytes that had caused marked narrowing of the disk space at the fourth and fifth cervical levels. In a second case, gross spondylotic changes in the cervical region coexisted with a sarcoma that was blocking the canal completely in the thoracic region.
Laminectomy, with section of the dentate ligament, was done in six cases of chronic cord compression by cervical spondylosis. No improvement resulted in one case, and in two the results were hard to assess. But in three there was partial success, and two of these patients were relieved of symptoms and enabled to return to their occupations. This experience indicated that surgical treatment should be reserved for the patient in whom the symptoms are recent and rapidly progressing.