Spinal cord injury (SCI) is usually thought of in the context of an acute injury event. With an increasingly aging population excessive narrowing of the spinal column (spinal stenosis) can lead to the emergence of a chronic spinal cord impairment analogous to a subacute spinal cord injury, which is referred to as cervical spondylotic myelopathy. Identifying spinal stenosis both by clinical and radiographic means provides an important foundation for informed care delivery. Understanding the dynamics of cysts within and surrounding the spinal cord may also considerably impact functioning neural elements and can cause secondary loss of neurologic function. Finally, the role of surgery in treating cervical spondylotic myelopathy – a chronic deterioration of spinal cord function – is presented and the data emerging from a large North American trial are presented. From the Series:Seventh Annual Harborview Spine Symposium: Improving Outcomes of Spinal Injury