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 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

References

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