Cervical Myelopathy

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Clinically Relevant Anatomy

Chronic cervical degeneration is the most common cause of progressive spinal cord and nerve root compression. Spondylotic changes can result in stenosis of the spinal canal, lateral recess, and foramina.  Spinal canal stenosis can lead to myelopathy, whereas the latter two can lead to radiculopathy.

The stenosis may be a result of anatomical changes to include hypertrophy of the facet joints (posteriorly) and of the ligamentum flavum, which becomes thick with age and encroach on the spinal cord.  The posterior longitudinal ligament may also decrease the diameter of the canal.

Mechanism of Injury / Pathological Process

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Clinical Presentation

Cervical spondylotic myelopathy can cause a variety of signs and symptoms.  The onset is insidious, which typically becomes apparent in persons aged 50-60 years.  About half of patients with cervical myelopathy have pain in their neck, scapular area or arms;  most have symptoms of arm and leg dysfunction.  Arm symptoms may include weakness, numbness (nonspecific/dermathomal) or clumsiness in the hands. Leg symptoms may include weakness, difficulty walking, and/or frequent falls.  In later cases, bladder and bowel incontinence can occur.  The first signs are often increased knee and ankle reflexes.  A Myelopathy is an upper motor neuron lesion and the patients may present with spasticity, hyperreflexia, clonus, Babinski and Hoffman's sign.  

Diagnostic Procedures

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Outcome Measures

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Management / Interventions

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Differential Diagnosis

Special Tests: (+) Clonus, (+) Hoffman's Sign

MRI may be useful to diagnose myelopathy.  Electromyography (EMG) and nerve conduction velocity (NCV) may help rule out peripheral nerve radiculopathy.

Key Evidence

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