Cervical Myelopathy (+Degenerative disc disease)

Question 1

What is cervical myelopathy?

Answer 1

• Compression of spinal cord at cervical spinal level
• Often due to degenerative spinal changes but can be malignancy or #

Question 2

Signs on examination of myelopathy

Answer 2

• Bilateral symptoms
• Non dermatomal parasthesia
• Non myotomal weakness
• Neck pain
• UMN signs - hyperrelfexia, extensor plantar reflexes
• Gait disturbance - spinocerebellar tracts affected
• Bladder and bowel incontinence - late stage
• Problem with fine motor skills eg doing up buttons

Question 3

Investigation for myelopathy

Answer 3

MRI - gold standard

Question 4

MRI signs of myelopathy

Answer 4

• AP width reduction
• Cross sectional evidence of cord compression
• SA space obliterated
• Signal intensity changes of cord

Question 5

Natural history of degeneration of discs resulting in myelopathy

Answer 5

• Disc dehydration
• –> tears in annulus fibrosus
• –> herniation of nucleus pulposus
• –> disc fibrosis and resorption
• = loss of disc height and increase suceptibility to injury
• Osteophytes then form and can cause spinal stenosis

Question 6

Presentation of degerative disc disease

Answer 6

• Localised back pain (muscle compensaton for loss of spinal balance)
• Neuropathic pain
• Can then be radicular pain or parasthesia
• Can get myelopathic picture or neurogenic claudication depending on location

Question 7

Signs on exam of degenerative disc disease

Answer 7

• Localised tenderness on palpation of spine
• Contracted paraspinal muscles
• Passive raise of extended leg may reproduce pain - Lasegue sign (+/- ankle dorsiflexion or cervical spine flexion)
• Painful extension of back/neck

Question 8

Treatment options for cervical myelopathy/degen disc disease

Answer 8

• Simple analgesia - paracetamol and NSAIDs
• Neuropathic pain relief if radiculopathy

Referral to pain clinic if persists >3 months

• Physio
• Surgery - posterior(inc laminectomy) or anterior (inc discectomy with spinal fusion)

Question 9

When to image degen disc disease?

Answer 9

• Red flags
• Radiculopathy >6 weeks
• Evidence spinal cord compression
• Imaging would significantly alter management

Question 10

Red flags to ask about with degen disc disease

Answer 10

• New faecal or urinary incontinence
• Saddle anaesthesia
• Immunosupression
• Chronic steroid use
• IV drug user
• Unexplained fever
• Significant trauma
• Known OP or metabolic bone disease
• New onset aged 50 or older
• Known or previous malignancy

Question 11

Aetiology of acute spinal cord compression

Answer 11

• Neoplastic
• Traumatic
• Infection
• Disc prolapses

Question 12

SCC symptoms

Answer 12

• Upper motor neurone signs - but absent reflex at level of compression
• Flaccidity is initial sign though (even though LMN symptom)
• Sensation and proprioception impaired at level below compression
• Autonomic involvement late stage - inc incontinence constipation or retention

Question 13

Management SCC

Answer 13

• High dose corticosteroids with PPI cover
• Surgery for decompression

Question 14

Investigation SCC

Answer 14

• Whole spine MRI