Cervical Myelopathy

Background

• Cervical Spondylosis is a general term for age-related wear and tear affecting the spinal discs of the neck.  The most common form of spondylosis is radiculopathy (i.e. nerve root compression).  Cervical myelopathy is spondylosis causing compression on the cervical cord.
• As with radiculopathy, this can be caused by disc herniation (but dorsomedial cf lateral herniation) or degenerative changes (osteoarthritis) with the development of bony lesions causing pressure on the cord and/or its blood supply
• A narrow spinal canal can predispose to myelopathy

Clinical Features

• Usually insidious onset
  • first symptoms are often disturbance of gait/balance; neck stiffness/discomfort (note that radicular pain is rare, and pain in the neck is unusual)
  • spasticity of the legs, then later also the arms
  • sensory loss in the upper limbs is common (less so in the lower limbs)
    • tingling, numbess, loss of proprioception (clumsiness)
• Acute deterioration can occur with trauma, particularly hyperextension injuries
• Eventually, loss of sphincter control can occur with severe disease

Investigations

• MRI spine

Management and Prognosis

• Surgical decompression is often performed to prevent further deterioration.  However, current symptoms/signs can persist and may never resolve fully
• Some cases will resolve without even surgery (i.e. variable)