3- Cervical Spondylotic Myelopathy

Question 1

What is spondylosis?

Answer 1

progressive degenerative process affecting the cervical vertebral bodies and intervertebral discs

Question 2

What is myelopathy?

Answer 2

caused by compression of the spinal cord due to narrowing (stenosis) of the central spinal cord

Question 3

What is cervical spondylotic myelopathy?

Answer 3

most common cause of myelopathy in adults over 55 years

Question 4

What are the problems associated with cervical spondylosis?

Answer 4

disc herniation, osteophyte formation, hypertrophy of the PLL and ligamenta flavum

Question 5

What can compression of the arterial and/or venous blood supply to the cord cause?

Answer 5

spinal cord ischemia

Question 6

Which motions exacerbate compression in the cervical spine?

Answer 6

flexion/extension

Question 7

What is the clinical presentation of cervical spondylotic myelopathy?

Answer 7

• Pain in neck with crepitus
• Numbness or paresthesias in the arms (dermatomal)
• Gait disturbance
• UMN findings in LEs (weakness, increased reflexes, increased tone, Babinski)
• LMN findings (weakness, atrophy, suppressed reflexes)
• Bladder dysfunction
• Lhermitte’s Sign
• Acute presentation (due to a fall or whiplash injury)

Question 8

What are some differential diagnoses for this?

Answer 8

ALS, Guillian-Barre, Normal pressure hydrocephalus

Question 9

Why is ALS a differential diagnosis?

Answer 9

You can have both UMN and LMN symptoms

Question 10

Why is Guillian-Barre a differential diagnosis?

Answer 10

absent reflexes may involve cranial nerves

Question 11

Why is normal pressure hydrocephalus a differential diagnosis?

Answer 11

cognitive dysfunction, apractic gait, indifference

Question 12

What can an EMG provide information about?

Answer 12

the presence and degree of anterior horn cell or spinal nerve root damage (also useful to exclude other diagnoses like ALS)

Question 13

What is the prognosis for patients with this?

Answer 13

The natural history is not well characterized… but deterioration can be

• progressive
• slow and stepwise with long periods of stability
• abrupt deterioration with minor neck injury

Question 14

What are come conservative measures?

Answer 14

• neck immobilization
• restriction of high-risk activities and environments
• pain management

Question 15

What are some pain management medications?

Answer 15

• NSAIDs
• Muscle relaxants
• Antidepressants

Question 16

What are some treatment options for this?

Answer 16

• Surgical decompression (complications can occur in up to 16%… death in 1%)

Question 17

What are some surgical complications?

Answer 17

• Nerve or nerve root injury (usually C5-6)
• Wound infections
• Epidural hematoma
• Dural tear

Question 18

When can acute myelopathy occur in patients?

Answer 18

Even with only mild or no baseline deficits

• minor neck trauma may be sufficient
• treatment is necessary as it is a neurologic emergency (with high dose IV corticosteroid)