Prolapse of a cervical disc in elderly patients with cervical spondylosis.

Compression of the spinal cord due to herniation or extrusion of a soft cervical disc is an eminently treatable condition with a favourable prognosis after excision of the disc.'4 By contrast, in patients in whom the compression is due to cervical spondylosisthat is, narrowing of the spinal canal at several levels by ligamentous hypertrophy and osteophytic bars-medical treatment is often unsatisfactory and the value of surgery debatable.58 Cervical spondylosis is a common incidental finding in the elderly, so when older patients present with compression of the spinal cord plain cervical radiographs will often show gross degenerative changes. If these changes are then interpreted as the cause of the patient's symptoms and signs (that is, "cervical spondylotic myelopathy") a coexisting prolapse of a cervical disc, which will be radiolucent on plain radiography, may be overlooked. The problem of making an accurate diagnosis is complicated further in the elderly by the prevalence of other conditions that can mask compression of the spinal cord such as osteoarthritis of the hips, stroke, and the carpal tunnel syndrome.