The inconsistent use of nomenclature to describe this entity has plagued both the reporting and understanding of CSM. Progress has similarly been stifled by the waxing and waning of symptoms that so often accompany the clinical presentation of CSM. Surgical approaches have, therefore, been chosen in situations in which an optimal result may not be expected and, conversely, they have not been chosen when a good result could have been expected. This confuses the student of CSM and further perverts the literature. The aforementioned waxing and waning clinical course presents significant decision-making dilemmas. This is particularly so in the elderly, in whom the risks of surgery may be significant and the benefits difficult to appreciate.