cervical myelopathy
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Etiology
- disc herniation
- hypertrophy of the ligamentum flavus
- ossification of the longitudinal ligament
- spinal cord neoplasm
- cervical spondylosis
- congenital anomaly
Clinical manifestations
- patients present with signs & symptoms of cervical spinal cord dysfunction with or without cervical radiculopathy
- neck pain, shoulder pain &/or pain in upper limbs may occur
- loss of manual dexterity
- gait & balance disturbances, sensory ataxia
- increase tone & heaviness in lower extremities
- Romberg's sign, Babinski's sign
- Lhermitte sign may be present (electric shock sensation with neck flexion)
- sensory loss in the hands or feet
- arm or hand weakness
- fecal or urinary frequency, urinary urgency, or urinary hesitancy
- upper-motor-neuron signs[5]
Radiology
- magnetic resonance imaging (MRI) of the cervical spine
Differential diagnosis
- vitamin B12 deficiency
- hyperactive deep tendon reflexes uncommon
- neck pain not a feature
- serum vitamin B12 close to or below upper limit of reference interval & serum methyl-malonate is low
Management
- surgical decompression improves neurologic function in some patients & prevents worsening in others
- age is an independent predictor of surgical outcome
- adults > 65 years of age do not have as much improvement in functional status after surgery as younger patients, but report similar quality-of-life improvements[3]
More general terms
More specific terms
References
- ↑ Medical Knowledge Self Assessment Program (MKSAP) 16, 19. American College of Physicians, Philadelphia 2012, 2021
Medical Knowledge Self Assessment Program (MKSAP) 20 American College of Physicians, Philadelphia 2025 - ↑ Geriatric Review Syllabus, 8th edition (GRS8) Durso SC and Sullivan GN (eds) American Geriatrics Society, 2013
- ↑ 3.0 3.1 Nakashima H et al. Does age affect surgical outcomes in patients with degenerative cervical myelopathy? Results from the prospective multicenter AOSpine International study on 479 patients. J Neurol Neurosurg Psychiatry 2015 Sep 29 PMID: https://pubmed.ncbi.nlm.nih.gov/26420885
- ↑ Rhee JM, Shamji MF, Erwin WM Nonoperative management of cervical myelopathy: a systematic review. Spine (Phila Pa 1976). 2013 Oct 15;38(22 Suppl 1):S55-67. Review. PMID: https://pubmed.ncbi.nlm.nih.gov/23963006
- ↑ 5.0 5.1 Rothaus C Cervical Spondylosis NEJM Resident 360. July 8, 2020 https://resident360.nejm.org/clinical-pearls/cervical-spondylosis
- ↑ NEJM Knowledge+ Question of the Week. August 18, 2020 https://knowledgeplus.nejm.org/question-of-week/1752/
Walters BC et al. Guidelines for the management of acute cervical spine and spinal cord injuries: 2013 update. Neurosurgery 2013 Aug; 60:82 PMID: https://pubmed.ncbi.nlm.nih.gov/23839357 - ↑ Kane SF, Abadie KV, Willson A. Degenerative cervical myelopathy: recognition and management. Am Fam Physician. 2020;102:740-750. PMID: https://pubmed.ncbi.nlm.nih.gov/33320508
- ↑ Funaba M et al. The utility of a prediction model using neurological examination findings for diagnosing degenerative cervical myelopathy. J Bone Joint Surg Am 2025 Aug 20; 107:1867. PMID: https://pubmed.ncbi.nlm.nih.gov/40638695
- ↑ McCormick JR, Sama AJ, Schiller NC, et al. Cervical spondylotic myelopathy: a guide to diagnosis and management. J Am Board Fam Med. 2020;33:303-313. PMID: https://pubmed.ncbi.nlm.nih.gov/32179614