Which structures commonly contribute to canal compromise in multilevel degenerative cervical spondylotic changes?

• A. Disc degeneration only
• B. Osteophytes only
• C. Facet arthropathy only
• D. Multilevel disc degeneration, osteophytes, facet arthropathy, and ligamentum flavum thickening

Answer: (D)

The idea being tested is that canal narrowing in multilevel degenerative cervical spondylosis comes from several structures contributing together across multiple levels, not from a single lesion. Anterior elements such as disc degeneration reduce height and may herniate or bulge, while osteophytes form along the vertebral bodies and uncovertebral joints, encroaching on the canal. Posteriorly, facet arthropathy can cause joint hypertrophy and related osteophytes, and the ligamentum flavum can thicken and buckle into the canal. When these changes occur at multiple levels, their effects add up to produce significant canal compromise. Therefore, the best answer reflects all contributing factors—multilevel disc degeneration, osteophytes, facet arthropathy, and ligamentum flavum thickening.