Cervical Myelopathy

This article is a stub.

Myelopathy is a rare condition that can occur with a central disc protrusion. Symptoms and signs of myelopathy occur in the upper limbs, trunk, and lower limbs. The examination is used to determine whether long tract signs are present such as hyperreflexia, spasticity, and a positive Hoffman's sign. Patients may present with signs only in the upper limbs. There is the absence of lower motor neurone signs

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

See Also

Cauda Equina Syndrome

Incomplete Cord Syndromes

Literature Review

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