Cervical spondylotic myelopathy is a leading cause of spinal cord dysfunction in the adult population. Affected patients represent a large subset of individuals who undergo operative treatment of degenerative cervical conditions. In a study of 450 patients undergoing anterior neck surgery for the treatment of degenerative disc disease, 61% presented with radicular symptoms, 16% had pure myelopathic symptoms, and the remaining 23% had a combination of myelopathy and radiculopathy1. The subtle clinical findings of early cervical spondylotic myelopathy make diagnosis difficult, and true natural history studies are unavailable. The patients or their relatives notice increasing awkwardness with gait and balance that they attribute to old age or arthritis of the lower extremity joints. Patients may report an insidious onset of clumsiness or diffuse numbness in the hands, resulting in worsening of handwriting or …