Cervical Spondylosis

Question 1

Cervical spondylosis presentation

Answer 1

Neck stiffness/crepitus/pain
Stabbing/dull arm/wrist pain
Lhermitte’s sign (neck flexion -> tingling down spine)

Question 2

Cervical spondylosis root compression (radiculopathy) signs

Answer 2

Pain/electric at level of compression

Numbness, dull reflexes, LMN weakness

Question 3

Cervical spondylosis cord compression signs

Answer 3

Progressive symptoms

UMN signs below, LMN at level

Question 4

Cervical spondylosis management

Answer 4

Urgent MRI + specialist referral to spinal/neurosurgery if night pain/weight loss/fever
Analgesia but if no improvement in 4-6 wks then surgical referral for decompression

Question 5

Cervical spondylosis pathogenesis

Answer 5

Degeneration of annulus fibrosus (disc coating) + osteophyte formation on adjacent vertebra results in narrowing of spinal canal + intervertebral foramina

Question 6

What is a syrinx

Answer 6

Tubular cavity in/close to central canal of cervical cord

Question 7

Syringomyelia causes

Answer 7

Typically blocked CSF circulation

Less commonly post-myelitis, cord trauma or AV malformation rupture, haemorrhage

Question 8

Syringomyelia presentation

Answer 8

Mean age of onset ~30yrs
Symptoms static for years then may worsen on cough/sneeze
Absent pain/temp but intact light touch/vibration/ proprioception
Horner’s syndrome
UMN leg signs
Wasting/weakness of hands ± claw hand

Question 9

What is syringobulbia

Answer 9

Syringomyelia with brainstem involvement causing nystagmus, tongue atrophy, dysphagia,
Vth CN sensory loss

Question 10

Syringomyelia treatment

Answer 10

Surgical decompression