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Cervical myelopathy

Diagnosis and Management of Cervical Myelopathy

Teaser: 

Sean Christie, MD, MSc, FRCSC,1 Aaron S. Robichaud, MD,2

1Associate Professor, Department of Surgery (Neurosurgery), Department of Medical Neurosciences, Dalhousie University, Halifax, Nova Scotia.
2Clinical Fellow, Department of Surgery (Neurosurgery), Department of Medical Neurosciences, Dalhousie University, Halifax, Nova Scotia.

CLINICAL TOOLS

Abstract: Cervical myelopathy is a degenerative disease that occurs secondary to direct spinal cord compression and compromise of spinal vasculature through a process of gradual spinal canal narrowing. Patients generally present with signs and symptoms of long tract compromise. Once myelopathy is suspected on clinical grounds, MRI is the test of choice to confirm canal stenosis and cord injury. Treatment involves surgical decompression, anteriorly and/or posteriorly of the spinal. Despite optimal management in this patient population, outcomes may be poor and are usually limited to halting progression of the disease rather than relieving deficits already present.
Key Words: Cervical myelopathy, cervical stenosis, degenerative spine disease, spondylosis.

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Cervical spondylotic myelopathy is a degenerative disease that results from compression of the spinal cord with subsequent cord injury and impaired conduction along the tracts contained within it.
Myelopathy is a clinical diagnosis based on signs and symptoms of spinal cord dysfunction and should not be used to refer to isolated imaging findings of spinal cord degeneration or stenosis.
MRI is the most sensitive test to identify cervical canal stenosis and injury to the cord and should be arranged when myelopathy is found on clinical evaluation to identify a specific diagnosis and guide management.
Surgical decompression can prevent progression of cervical spondylotic myelopathy, and in some patients improve gait and hand function.
Cervical myelopathy can be differentiated from radiculopathy on clinical exam by the presence of upper motor neuron signs as a result of injury to the spinal cord, which will be absent in radiculopathy.
MRI is helpful in working up cervical spondylotic myelopathy as it allows visualization of the elements causing compression, provides an estimate of the extent of stenosis through loss of CSF space surrounding the cord, and allows identification of cord injury manifest as hyperintense signal change in the cord on T2 weighted imaging.
Patients with symptomatic cervical myelopathy should be referred to a spine surgeon for evaluation and management.
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Related Terms: Back Health, Cervical myelopathy, cervical stenosis, degenerative spine disease, spondylosis