• Paul Monaro

Cervical Spine - Myelopathy

Cervical cord compression, or cervical stenosis, can develop due to degenerative changes in the discs and uncovertebral or zygapophyseal joints. It can also be present due to heredity factors. Occasionally it will occur acutely due to a significant traumatic event or the presence of a tumor. A structurally narrow cervical cord space identified on lateral x-ray, MRI, or CT scan is often asymptomatic. If it becomes symptomatic and results in dysfunction it is known as cervical myelopathy.

Symptoms:

- Incoordination of one or both lower limbs

- Spastic weakness

- Paraesthesia or numbness in one or both extremities

- Shooting pains or ‘electric shocks’ in the arms or legs

- Loss of fine motor control, e.g. handwriting.

- A feeling of heaviness in the limbs

- Symptoms of cervical radiculopathy

- Proprioceptive dysfunction

- Sphincter dysfunction

- Symptoms may be worse on forward neck flexion


Signs:

Cord compression affects the long tracts in the spinal cord, leading to increased muscle tone and hyperreflexia. Special tests for cervical myelopathy include:

- Hyperreflexia of patella or Achilles tendon reflex

- Positive Babinski test – scratching the sole of the foot results in 1st toe extension instead of flexion.

- Presence of clonus – on brisk passive dorsiflexion of the ankle, the patients foot moves rapidly up and down

- Difficulty with tandem walking (placing one foot in front of the other), due to increased muscle tone in the lower limbs.

- In the latter stages there may be muscle atrophy & loss of deep tendon reflexes.


Imaging: CT myelography has been extensively used in the past, however MRI is the imaging of choice to assess the cord, confirm the diagnosis, and to rule out the presence of red-flags, such as a tumor.


Treatment: An asymptomatic cervical stenosis should be monitored, and the patient educated about future symptoms that warrant further investigation. Cervical myelopathy obviously requires a neurosurgical consult.


#paulmonarophysio #neckpain #cervicalspine

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