Patient recourses
NHS Inform Cervical Myelopathy
Definition
Cervical Myelopathy (also known as Degenerative Cervical Myelopathy) is the most common atraumatic spinal cord condition in adults. It occurs when degenerative changes cause spinal cord compression and is characterised by loss of fine motor control and coordination, gait dysfunction, and genitourinary disturbance.
A diagnosis of cervical myelopathy is made when an individual presents with clinical symptoms and corresponding MRI evidence of myelopathic cord compression.
Prognosis
Cervical myelopathy symptoms exist on a spectrum of severity. The natural history is relatively unknown. However, there is moderate evidence that 20%-62% of patients with symptomatic cervical myelopathy deteriorate by ≥1 point on the modified Japanese Orthopaedic Assessment (mJOA) scale within 3-6 years.
There is moderate evidence that patients with cervical myelopathy worsen in performing activities of daily living with non-operative treatment at 1year (6%), 2year (21%), 3year (28%), and 10year (56%) follow-up.
Typical Signs & Symptoms
The onset is usually insidious, and diagnosis is based on history, physical examination, and imaging findings.
Common symptoms include:
- Stiff neck or legs
- Altered sensation in the legs
- Altered balance and staggering when walking
- Bilateral hand numbness
- Loss of dexterity (difficulty doing up buttons/holding a pen)
- Clumsiness in the hands.
Signs include:
- Hyper-reflexia
- Abnormal pathological reflexes (e.g. positive Hoffman, plantar response, ankle clonus)
- Increased tone
- Motor deficits
- Atrophy of intrinsic hand muscles
- A broad-based unstable, ataxic gait
- Bowel and bladder dysfunction
Risk factors for poor outcome
It is suggested that the severity and length of time patients have symptoms prior to treatment results in a poorer outcome.
Other considerations
mJOA scale is the most widely used outcome scale to measure the severity of cervical myelopathy. It has moderate internal consistency. The reliability of the mJOA has not been established.
Differential Diagnosis
Differential diagnoses include intracranial, demyelinating, motor neuron, infectious, inflammatory, and metabolic diseases. In a recent narrative review, it was suggested that vitamin B12 deficiency, Multiple sclerosis (MS), and peripheral nerve entrapment are differential diagnoses of cervical myelopathy.
M.A & P.A – 14-05-26
