Cervical spondylotic myelopathy (CSM) is the most serious type of cervical spondylosis among all types of cervical spondylosis, and it has an insidious onset, which can easily be misdiagnosed as other diseases and delay the diagnosis and treatment. It is a secondary pathological change such as degenerated cervical intervertebral disc and osteophytes at the posterior edge of the vertebral body that stimulates and compresses the spinal cord and causes spinal cord conduction dysfunction. 1, symptoms and signs: 40 to 60 years old patients are common, the onset of slow, spinal cord cervical spondylosis accounts for about 10% to 15% of cervical spondylosis. The clinical symptoms are numerous, including sensory or motor disorders, cervical nerve or spinal cord lesions, acute onset due to minor trauma, paraplegia at the onset, and after a number of days, although the paralysis has improved, most of the final remains of neurological dysfunction; most do not have or have only minor symptoms of neck and shoulder pain, and the manifestation of nerve and spinal cord dysfunction is often not easy to attract attention in the early stage of the disease, with the development of the disease, can gradually appear obvious. With the development of the disease, obvious symptoms of spinal cord compression and even tetraplegia may gradually appear. Therefore, it is of positive significance to understand the early symptoms of spinal cord cervical spondylosis for early diagnosis and timely treatment of the disease, and the early symptoms of CSM are classified as follows: ① Lower extremity symptoms: neurological dysfunction of one or both lower extremities, such as weakness, instability, trembling, weak legs, and easy to fall; some of them are simple sensory dysfunction of lower extremities, such as abnormal sensation of both feet, numbness of both lower extremities, or sensory and motor dysfunction. There are also cases where sensory and motor disorders exist at the same time. ② Upper limb symptoms: simple motor disorders of one or both upper limbs, simple sensory disorders or both sensory and motor disorders. Common symptoms include numbness, soreness, burning or coldness, pain or weakness, easy dislodgement of objects, and trembling. It may occur in one or more fingers, sometimes only in the tips of five fingers, some manifest in the scapula, shoulder, upper arm or forearm; some occur simultaneously in the proximal or distal part of the upper limbs; some radiate along the nerve roots. (③) Extremity symptoms: It can be manifested as simple sensory disorders such as numbness in both feet and calves and ulnar side of both hands. Some short-term sensory and motor disorders appear one after another in the extremities, such as numbness in the ring and little finger of the left hand the next day after working for a long time with the head down, followed by numbness in the ring and little finger of the right hand, followed by numbness and weakness in both lower extremities, difficulty in lifting the legs, unstable gait and easy to fall. ④ Sacral nerve symptoms: manifested as urination and defecation disorders, such as abnormal perianal or perineal sensation, frequent urination, urgent urination, incomplete urination or waiting for urination, and constipation. Once the above-mentioned early symptoms appear, the possibility of the disease should be thought of, the patient’s symptoms are sometimes good and sometimes bad, in a wave-like progressive aggravation, such as: tightening of the muscles of the lower extremities, slow lifting, can not walk fast, more can not run; feet appear to step on cotton-like feeling; neck stiffness, the back of the neck is easy to cause numbness of the limbs, followed by one or both upper extremities numbness, pain, hand weakness, holding small objects easy to fall off, can not buckle In some patients, urinary retention occurs; some patients also show tightness in the chest and abdomen, i.e., “girdling sensation”. These typical symptoms are important for the early diagnosis of CSM. At least one or more tendon reflexes, one or more pathological reflexes, especially Hoffmann or Rossolimo must be present, and one of patellar clonus or ankle clonus, are diagnostic values. Clinical symptoms play a very important role in the early diagnosis of CSM. If the possibility of CSM can be realized after the appearance of early symptoms and after detailed physical examination and imaging, the treatment time can be shortened, the cure rate can be significantly improved, and the disability rate can be reduced. 2, imaging: 2.1 X-ray: cervical spine straightened or angled backward on the front and side views, multiple narrowing of the cervical space; osteophytes, especially posterior spurs are more common; bone spur formation in the hook spine joint. In oblique views, narrowing of the intervertebral foramen, overlapping of small joints, or ossification of the collateral ligament are seen. The normal sagittal diameter of the cervical spinal canal is between 16 and 17 mm in the national population; if it is less than 13 mm, it is considered that there is spinal stenosis, and if it is less than 10 mm, there is often spinal cord dysfunction; if the mid-sagittal diameter of the spinal canal/vertebral body mid-sagittal diameter is <75% in lateral cervical spine films, it is considered that there is developmental cervical spinal stenosis; from lateral cervical hyperflexion and hyperextension films, the cervical spine unstable segments can be analyzed, and cervical instability can be judged from the following aspects: namely, the vertebral body The distance between the line of the posterior edge and the line of the lower edge of the slipped vertebral body intersecting the point to the posterior edge of the same vertebral body ≥ 2 mm or the angle between the vertebral bodies > 11° and the vertebral body slipping 2 to 3 mm is considered unstable. Currently, cervical instability is considered a problem worthy of attention and is one of the important factors in the pathogenesis of spinal cervical spondylosis. Repeated friction of the spinal cord at the posterior edge of the vertebral body during cervical extension and flexion activities, especially in the presence of developmental cervical spinal stenosis and formation of degenerative posterior osteophytes, etc., causes pathological damage to the spinal cord due to microtrauma to the spinal cord. 2.2 CT scan: Bone spurs at the posterior edge of the vertebral body, size of the spinal canal, ossification of the posterior longitudinal ligament, calcification of the ligamentum flavum, and disc herniation can all be demonstrated. 2.3 Magnetic resonance imaging (MRI): higher resolving ability, visible disc degeneration and signal changes, especially for multi-segmental degenerative disc protrusion spinal canal, visible dural sac, spinal cord with or without compression and compression and dorsal and ventral compression of the spinal cord, whether the spinal cord is thinning (atrophy), degeneration, whether there is a cavernous tumor, etc. MRI has gradually replaced myelography. 2.4 Lumbar puncture (Quay test): those with complete obstruction or partial obstruction indicate spinal cord compression, but the cause and site of compression cannot be determined. In those with obstruction, cerebrospinal fluid protein is often higher than normal (40 mg%), and if protein is higher than 200 g/L (200 mg%), spinal cord tumor should be considered. For early sensory and motor changes in the upper limbs, lower limbs or extremities, on the basis of excluding cranial nerve damage, attention should be paid to the occurrence of spinal cord type cervical spondylosis, and it is not difficult to make a diagnosis if the patient’s history is carefully questioned, the body is carefully examined, and cervical spine X-ray films are read and analyzed in detail. This can help clarify the diagnosis and guide the choice of treatment options such as surgery. 3, the diagnosis of spinal cord cervical spondylosis: ① clinical manifestations of cervical spinal cord damage, no discomfort in the neck but clumsy hand movements, failure of small movements, a feeling of banding in the chest, unstable gait, easy to fall; ② increased muscle tone of the limbs, gradually appearing spastic paralysis of the limbs, tendon reflex hyperactivity, Hoffmanns sign positive, may appear ankle clonus and patellar clonus; ③ trunk and lower extremities numbness or the appearance of sensory impairment planes (3) numbness of the trunk and lower extremities or the presence of sensory impairment planes, with lamellar or striated areas of weakening; (4) lateral cervical spine X-ray or CT film showing osteophytes at the posterior edge of the vertebral body and spinal canal stenosis; (5) MRI showing wave-like compression of the spinal cord, and in severe cases, the spinal cord may become thin or bead-like.