Cervical Myelopathy

This article is a stub.

Clinical Features

• Gait dysfunction and sensory ataxia due to a combination of proprioceptive defects, hypertonicity, and weakness.
• Deep sensation defects in severe disease involving proprioception and vibration sense, due to posterior column compression.
• Paraesthesias and numbness.
• Compression of pyramidal and extra pyramidal tracts causing spasticity, weakness, and abnormal muscle contraction.
• Lower limb stiffness and dragging feet
• Upper limb fine motor control deficits
• Upper limb symptoms may be more prominent intermittently due to central cord compromise
• Urinary incontinence in long standing disease
• Neck pain may be a feature but is not normally prominent, and does not tend to occur early unlike cervical radiculopathy
• Upper motor neurone pattern abnormalities in the lower limbs, and lower motor neurone abnormalities in the upper limbs
• Special Tests
  • Lhermittes sign (electric shock down torso on neck flexion)
  • Foot tapping test
  • Hand clenching test
  • With back against the wall, unable to extend head back to touch the wall.
  • Hoffman test, facilitated by cervical extension

Imaging

MRI is best. Severe cord atrophy suggests a poor prognosis.

Differential Diagnosis

• Amyotrophic lateral sclerosis
• Multifocal motor neuropathy
• Multiple sclerosis
• Syringomyelia
• Peripheral neuropathy

Treatment

Conservative

Surgery

Literature Review

Literature Review

Reviews from the last 7 years: review articles, free review articles, systematic reviews, meta-analyses, NCBI Bookshelf

Articles from all years: PubMed search, Google Scholar search.

TRIP Database: clinical publications about evidence-based medicine.

Other Wikis: Radiopaedia, Wikipedia Search, Wikipedia I Feel Lucky, Orthobullets,