Cervical myelopathy and radiculopathy

Question 1

What is cervical myelopathy?

Answer 1

A dysfunction of the cervical spinal cord leading to a number of slow progressive neurological presentations

Question 2

What are some early, slow progressive symptoms of cervical myelopathy?

Answer 2

Clumsiness of hands and feet
Mild gait disturbance
Paraesthesia of upper and lower extremities

Question 3

What are some of the later symptoms of cervical myelopathy?

Answer 3

Loss of coordination
Changes in gait and stiffness
Changes in bowel or bladder function

Question 4

What are the 3 main classification systems in place for cervical myelopathy?

Answer 4

Ranawat
Nurick
Japanese orthopaedic association score

Question 5

What are the 4 stages of Ranawat classification of cervical myelopathy?

Answer 5

I - Pain, no deficit
II - Subjective numbness, hyper-reflexia
IIIa - Objective weakness, still ambulant
IIIb - Objective weakness, non-ambulant

Question 6

What are the 4 grades of the Japanese orthopaedic association score in cervical myelopathy?

Answer 6

I - Upper limb motor dysfunction
II - Lower limb motor dysfunction
III - Sensory symptoms
IV - Bladder symptoms

Question 7

What are some causes of cervical myelopathy? (4)

Answer 7

Disc osteophyte complex formation
Ligamentous hypertrophy
Degenerative spondylolisthesis
Compressive lesions (e.g. tumours, pannus, stenosis)

Question 8

What investigations are required in cervical myelopathy?

Answer 8

1st line: MRI and CT myelogram
MR myelogram if CT myelogram is contraindicated

Question 9

How is cervical myelopathy managed?

Answer 9

Those with mild symptoms can be treated conservatively with analgesia and physiotherapy, however, in those with more serious disease, surgery is indicated

Question 10

What are some surgical options in cervical myelopathy?

Answer 10

• Anterior cervical discectomy and fusion
• Cervical laminectomy
• Cervical laminoplasty

Question 11

What is cervical radiculopathy?

Answer 11

Cervical radiculopathy is a dysfunction of the cervical nerve root, resulting in pain radiating from the neck down and into the arm, with some patients experiencing numbness and/or weakness in the upper extremity

Question 12

What are some causes of cervical radiculopathy?

Answer 12

Cervical disc prolapse
Vertebral osteophytes
Compressive lesions (e.g. tumours)

Question 13

How would C5 cervical radiculopathy present?

Answer 13

This is a rare condition that will often cause pain radiating to the shoulder

Question 14

How would C5 cervical radiculopathy be tested for?

Answer 14

Biceps reflex

Question 15

How would C6 cervical radiculopathy present?

Answer 15

This makes up around 20% of cases of cervical radiculopathy; it presents with pain radiating to the thumb and lateral forearm

Question 16

How would C6 cervical radiculopathy be tested for?

Answer 16

Brachioradialis reflex

Question 17

How would C7 cervical radiculopathy present?

Answer 17

This is the most common and makes up around 70% of cases; it presents with pain radiating to finders 2 and 3

Question 18

How would C7 cervical radiculopathy be tested for?

Answer 18

Using the triceps reflex

Question 19

How would C8 cervical radiculopathy present?

Answer 19

This makes up around 10% of cases; it presents with pain radiating to fingers 4 and 5

Question 20

How would C8 cervical radiculopathy be tested for?

Answer 20

Using the finger reflex

Question 21

What investigations are used in cases of cervical radiculopathy?

Answer 21

MRI and CT myelogram (Dye introduced to the spinal column)

Question 22

How is cervical radiculopathy usually managed?

Answer 22

The most common management in cervical radicuopathy is conservative, using analgesics and physiotherapy, which has a 90% improvement rate

2nd line treatment then involves surgery for arm pain and in cases of progressive neurological deficit

Question 23

What surgical options are available in cervical radiculopathy?

Answer 23

• Anterior cervical discectomy and fusion (ACDF)
• Anterior cervical discectomy and disc replacement (ACDR)
• Posterior cervical foraminotomy