Cervical Myelopathy Quiz

Cervical Myelopathy is a reduction of the sagittal diameter of the cervical spinal canal.  The canal is normally 17-18mm wide in adults.  It  can be caused by a mechanical reason such as a disc lesion or degenerative stenosis (most common level C5/6, C6/7), bone spurs, traumatic dislocation or fracture or medical issues such as transverse myelitis, MS, neuromyelitis optica (immune disorder that affects the optic nerve and the spinal cord), viral and autoimmune disorders, neoplasms, epidural or subdural hemorrhage.  It is the most common cause of spinal cord dysfunction in adults over the age of 55.

Signs and symptoms are neck pain and stiffness with or without shoulder pain and stiffness. Progressive disability is a typical history. Wide based ataxic gait or gait disturbances, loss of hand dexterity, paresthesia in one or both arms or hands, changes in handwriting, loss of fine motor ability of the hands, hyperreflexia, positive plantar response, positive Hoffman’s, Lhermitte’s sign during slump testing especially neck flexion/extension, urinary retention which can progress to overflow incontinence and low back pain can be present.  Plantar response is the most reliable screening test.

Clinical Prediction Rule for Cervical Myelopathy

Clinical tests for cervical myelopathy include a plantar response (Babinski, clonus), Hoffman’s sign, deep tendon reflexes, hand withdrawal reflex, suprapatellar quadriceps test and the inverted supinator sign.

Cluster test for cervical myelopathy

  • gait deviation/ataxiaor unsteadiness
  • (+) Hoffman’s sign
  • (+) Inverted supinator sign
  • (+) Babinski
  • over the age of 45

If three of five or four of five of these signs are present, the probability of the diagnosis is 94-99%. [i]

[i] Chad Cook, Christopher Brown, Robert Isaacs, Matthew Roman, Samuel Davis, and William Richardson. Clustered clinical findings for diagnosis of cervical spine myelopathy. J Man Manip Ther. 2010 December; 18(4): 175–180.

 

 

Differential Diagnosis of the Spine

 

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