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Cervical Spine Myelopathy

· Myelopathy,spinal cord,compression,Orthopaedics,Orthopedic Surgery

The spinal cord runs inside of the spinal canal. Myelopathy can occur due to compression of the cervical spinal cord. Pain is usually absent or poorly defined with vague sensory and motor changes. Symptoms typically include a slow, wide, broad based ataxic gait pattern. It is also common for the patient to lose fine motor function in the hand and dexterity, this can include the inability to write, hold a coffee cup, or button a shirt.

In myelopathic hand syndrome, you will notice thenar atrophy. The physician may test the patient’s Grip and Release Sign. If the patient is unable to make a fist and release 20 times in 10 seconds, this is a positive indication. Additionally, the physician may test the patient’s Finger Escape Sign. During this exam, the patient will keep their fingers extended but, the ulnar digit tends to abduct. If the ulnar digit abducts, this is a positive indicator.

Pathologic long tract signs will be observed by performing the Hoffman’s, Babinski, Clonus, Finger Escape, and L’hermitte’s signs. The Hoffman’s Sign is done by flicking the nail of the middle or ring finger to produce flexion of the index finger to the thumb. The Babinski’s sign is tested by running a sharp instrument along the lateral border of the foot from the calcaneus produces extension of the big toe and fanning of the other toes. The Clonus Sign is indicated by involuntary sustained movement of the ankle muscles with firm passive continuous stretch. During the L’hermitte’s Sign, neck flexion causes an electric shock sensation and paresthesia which radiates into the upper and lower extremity. Other significant signs include: hyperreflexia, lower extremity dysfunction and spasticity, as well as late bowel and bladder involvement.

Causes of Cervical Spine Myelopathy

  • Cervical Spondylothesis
  • OPLL in Asians
  • Tumor
  • Congenital stenosis of the cervical spinal canal
  • Herniated disc

Differential Diagnosis include: syringomyelia, a spinal cord tumor, and multiple sclerosis. Patients with MS will have cranial nerve involvement and their jaw-jerk test is positive. Amyotrophic Lateral Sclerosis (ALS) affects both upper and lower extremities with no sensory changes.

Nurick Classification deals with the patient’s walking ability and gait. This ranges from normal to wheel chair bound.

An MRI is the best study to show Cervical Spine Myelopathy. It shows the compression and the changes in the spinal cord (bright signal in T2).

Prognosis

Unfortunately, this condition does not improve without surgery. It tends to progress and worsen in a step-like deterioration fashion with periods of stable symptoms.

Treatment

Decompression and fusion is recommended in cases where the symptoms are progressive or severe. The prognosis for recovery is better in patients with early surgery. Surgery is usually done anteriorly with decompression and fusion. Surgery is usually done with anterior cervical discectomy and fusion (ACDF). In patients with lower back pain and gait disturbance, look into the spinal cord, especially into the cervical spine. Do not focus on the lumbar region and order a cervical spine MRI.

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