Cervical Myelopathy

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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 talking test
  • Hand clenching test
  • With back against the wall, unable to extend head back to touch the wall.
  • Hoffman test, facilitated by cervical extension