Dr. Ebraheim’s educational animated video describes the condition of Cervical Spine Myelopathy.
Myelopathy can occur due to compression of the cervical spinal cord. Pain is usually absent or poorly defined with vague sensory and motor changes
Signs and symptoms
•Wide slow broad-based ataxic gait pattern.
•Poor hand fine motor function and dexterity occurs early (writing, unable to hold a coffee cup or button a shirt).
•Myelopathic hand syndrome
•Thenar atrophy
positive grip and release sign, patient is unable to make a fist and release 20 times in 10 seconds.
•Positive finger escape sign: when the patient keeps the fingers extended, the ulnar digit tends to abduct.
•Pathological long tract signs will be seen consisting of Hoffman's, Babinski, clonus, finger escape and L’hermitte’s signs, in addition to hyperreflexia.
•Hoffman’s sign: flicking the nail of the middle or ring finger to produce flexion of the index finger to the thumb.
•Babinski: running a sharp instrument along the lateral border of the foot from the calcaneus produces extension of the big toe and fanning of the other toes.
•Clonus sign: nonvoluntary sustained movement of the ankle muscles with from passive continuous stretch.
•L’hermitte’s sign: neck flexion causing electric shock sensation and paresthesia radiating into the upper and lower extremity.
•Lower extremity dysfunction and spasticity.
•Bowel and bladder involvement is late.
Causes
•Cervical spondylothesis
•OPLL in Asians
•Tumor
•Congenital stenosis of the cervical spine canal
•Herniated disc.
Differential diagnosis
•Syringiomyelia
•Spinal cord tumor
•Multiple sclerosis: will have cranial nerve involvement. The jaw jerk test is positive.
•Amyotrphic lateral sclerosis (ALS): affects both iupper and lower extremities with no sensory changes.
Nurick classification
•Deals with walking ability and gait.
•Ranges from normal to wheel chair bound (in training exam).
MRI is the best study: it shows the compression and the changes in the spinal cord (bright signal in T2).
Prognosis:
•The condition does not improve without surgery.
•It tends to be progressive and gets worse in a steplike deterioration fashion with periods of stable symptoms (in-training exam).
•Decompression and fusion in case the symptoms are progressive or severe.
•Prognosis for recovery is better in patients with early surgery.
Surgery is usually done anteriorly with decompression and fusion.
Surgery is usually done with anterior cervical discectomy and fusion (ACDF).
Decompression
Bone graft for fusion
Plate&screws
In patient with low back pain and gait disturbance, look into the spinal cord, especially into the cervical spine. Don’t focus on the lumbar region, get a cervical spine MRI.
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