Cervical Myelopathy Flashcards
What are two clinical signs indicative of cervical myelopathy?
1) Hand clumsiness
2) Gait imbalance
What are causes of cervical myelopathy?
1) degenerative cervical spondylosis (most common)
2) tumor
3) abscess
4) OPLL
5) trauma
What physical exam findings are common in cervical myelopathy?
1) weakness (LE weakness is concerning)
2) Wartenburg’s sign (hand intrinsic weakness)
3) Grip and release test (grip release x20 in 10s)
4) Hoffman’s sign
5) clonus (100% specific, 15% sensitive)
6) Lhermitte sign (cervical flexion produces radicular pain)
In the non-operative treatment of cervical myelopathy, what group of patients have been shown to have better outcomes?
Those with large (>70mm^2) of transverse area of the spinal cord
What is the treatment algorithm for cervical spine myelopathy?
1-2 levels go anterior only; ACDF/corpectomy/hybrid
3 levels or more:
If >10 degree anterior kyphosis then anterior & posterior fusion
If
What are common complications with surgical treatment of cervical spine myelopathy?
1) pseudoarthrosis with fusions
2) C5 palsy
3) recurrent laryngeal n. palsy (get ENT after 6 wks or prior to revision surgery)
4) hardware failure or migration
What surgical approach is used for anterior fusion in cervical spine?
Smith-Robinson
1) Incise fascia over platysma
2) Split platysma with finger and identify anterior edge of SCM
3) Retract SCM lateral
4) Retract strap muscle (sternohyoid, sternothyroid) medially
5) Identify carotid pulse, retract sheath lateral
6) Cut through prevertebral fascia
7) Identify superior/inferior thyroid aa.
8) Splint longus colli muscles and ALL
In laminoplasty for cervical spine myelopathy what is a predictor of a poor outcome?
Local kyphosis angle >13 degrees
What clinical signs are a/w upper motor neuron disease?
Spasticity, clonus, muscle weakness, exaggerated DTRs
