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Cervical Myelopathy
Definition: Cervical myelopathy is the result of spinal cord compression in the cervical spine.
Causes: Any space occupying lesion within the cervical spine with the potential to compress the spinal cord can result in a cervical myelopathy. Examples include: cervical spondylosis where there is a progressive loss of intervertebral disc height and increased apposition of the zygoapophyseal joints. This can lead to the formation of osteophytes that may protrude into the spinal canal. Another example is a cervical disc prolapse, where the nucleus pulposus causes a stenosis within the vertebral canal both mechanically and chemically irritating the spinal cord lying within it.
Examination: The presentation of a cervical myelopathy varies in accordance to the severity of the spinal cord compression, and it's location. Commonly, patients will report some sort of pain in the neck and/or arms and legs. The majority of patients suffering from cervical myelopathy will have some limb dysfunction. Urinary urgency is also a common symptom and in late cases bowel and bladder dysfunction may be evident.
Orthopaedic tests for cervical myelopathy.
Given the numerous potential causes of cervical myelopathy, it is important to rule out sinister pathologies such as tumours and vascular events from other more benign causes such as cervical spondylosis.
The practitioner should assess the patient for signs of upper motor neurone dysfunction: hypereflexia, clonus, spasticity, clasp-knife response, present Babinsky.
Valsalva manouveur: the patient is instructed to forcibly exhale against their closed airways. An aggravation in symptoms indicates a positive.
If a cervical myelopathy is suspected than an MRI is warranted.