Cervical Myelopathy Flashcards
(11 cards)
Features of degenerative cervical myelopathy
Neck pain and stiffness
Unilateral or bilateral limb or body pain
Body numbness, paraesthesia, weakness or stiffness
Loss of manual dexterity, balance, poor coordination, falls
Disturbance of bladder or bowel function
Differential diagnosis of cervical myelopathy
Motor neurone disease
Myasthenia gravis
(Rare, affects women under 40 and men >60 weakness starts in face, worse when tired better following morning, disease course typically flares and emissions)
Myopathies
MS
Tumour
Vascular malformation / cavernoma
(A tangle of blood vessels that form on, in or near the spinal cord or brain) rare but serious.
Subacute combined degeneration of the spinal cord
/ B12 deficiency
Increased prevalence from recreational use of nitrous oxide
Objective findings
Upper motor neurone signs UL and LLs
Weakness in a segmentation pattern - due to co-existant radiculopathy
Or weakness in segmental pattern - extensor more affected in UL and flexor in LL
(Due to lateral corticospinal tract compression)
Sensory loss in limbs and trunk
Atrophy of small m of hand
Broad based unsteady gait
Points about MRI results
Surgeons will treat MRI not symptoms due to risk of future spinal cord damage
MRI may not correlate with symptoms- mild compression can cause severe disease
MRI in supine so may not see any compression but can still diagnose Degenerative CM
Progressive / severe symptoms urgent MRI
Mild / stable symptoms routine MRI
Role of electrophysiological investigations
EMG - muscle
NCS - nerve
Done to peripheral n to assess and localise a radiculopathy or rule out peripheral neuropathy or n entrapment
These tests do not confirm DCM but exclude other causes for pain
How to measure severity of DCM
Modified Japanese orthopaedic association (mJOA)
18 point scale
Mild 15-17
Moderate 12-14
Severe 0-11
Categories included:
UL motor
LL motor
UL sensory
Sphincter
When to operate and types of surgery
Moderate to severe mJOA will likely be offered surgery
Mild: either surgery or supervised trial of structured rehabilitation and regular follow up.
Asymptomatic SCC with no signs of myelopathy counselled on risk of progression but not offered surgery.
Asymptomatic SCC with evidence of radiculopathy may be offered surgical or non surgical intervention.
Surgery alleviates mechanical stress on spinal cord.
Anterior approach = cervical discectomy
Posterior approach = laminectomy.
Aim to halt disease progression but may get some improvement in symptoms.
Conservative management
Bracing
Analgesics
Therapeutic exercise
Avoid high risk activity
What is DCM?
Degenetative Cervical Myelopathy
Progressive Spinal cord injury caused by arthritis.
Typically through chronic tissue compression from spinal canal narrowing from degenerative* and / or congenital changes.
- eg. Disc prolapse, osteophytes, ligament hypertrophy or calcification. I.e. cervical spondylosis
It is common and often asymptomatic
The functional decline is rarely linear, it can be stable, step wise or on advanced stage decline may accelerate.
Physical tests for cervical myelopathy?
Grip and release test
How many in a 10 second period
Over 20 is normal- will reduce in elderly naturally
Finger escape sign
Hold fingers extended and adducted, small finger abducts due to weakness of intrinsic m
Cluster of >3-4 our of 5 findings correlate with 94-99% probability of the condition
Age >45
Babinski +ve
Hoffman +ve
Gait deviation (spastic, wide BOS or ataxia)
Inverted supinator reflex +ve
Inv sup = brachioradialis reflex gives finger flexion or elbow extension (and absent biceps and increased triceps) instead of expected elbow flexion
Differences between myelopathy and myopathy
Myelopathy is damage or dysfunction of spinal cord
Myopathy is disease of the muscle itself. Typical symptoms weakness especially proximal to distal.
Reflexes are preserved in Myopathies and affected in myelopathies.
Types of Myopathies:
Inherited - genetic basis eg muscular dystrophy
Acquired -
Medical disorders such as autoimmune disease
Toxic Myopathy
Medication eg statin or alcohol or others
Endocrine Myopathies
Where hormones interfere with muscle function eg low thyroid > high thyroid, hyperparathyroidism resulting in increased calcium levels
Adrenal Addison disease and Cushing syndrome
Infectious Myopathies
Viral infections, HIV
Lyme disease, Bacterial, parasitic, fungal infections
Electrolyte imbalance
Potassium high or low
Magnesium high
