Cervical Spondylotic Myelopathy

Question 1

What is spondylosis?

Answer 1

A progressive degenerative process affecting the cervical vertebral bodies and intervertebral discs

Question 2

What is myelopathy caused by?

Answer 2

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

Question 3

What is the most common cause of myelopathy in adults over 55 years?

Answer 3

Cervical spondylotic myelopathy

Question 4

What does cervical spondylosis result in?

Answer 4

Disc herniation, osteophyte formation, hypertrophy of the posterior longitudinal ligament and ligamenta flava

Question 5

What movements can exacerbate symptoms associated with spondylosis?

Answer 5

flexion and extension

Question 6

If there is damage to the anterior horn cells what is the result?

Answer 6

LMN deficits, such as weakness, atrophy, and decreased reflexes

Question 7

Describe the clinical presentation of cervical spondylotic myelopathy

Answer 7

• neck pain
• neck creptius
• numbness or paresthesias in the arms in a dermatomal pattern)
• gait disturbances
• sensory disturbance, such as reduced joint position and vibratory sense, loss of pain sensation
• UMN signs in the LEs
• LMN signs in the arms and hands
• bladder dysfunction
• Lhermitte’s sign

Question 8

What type of gait disturbances can be expected with cervical spondylotic myelopathy

Answer 8

spastic and scissoring in quality

Question 9

What are the UMN signs?

Answer 9

weakness, increased reflexes, increased tone, and the Babinski sign

Question 10

What is Lhermitte’s sign?

Answer 10

An electrical sensation that runs down the back and into the limbs. In many patients, it is elicited by bending the head forward.

Question 11

What are 3 diseases that must be rules out?

Answer 11

• ALS
• Guillian Barre Syndrome
• Normal pressure Hydrocephalus

Question 12

What can be defined as total or partial loss of the ability to perform coordinated movements or manipulate objects in the absence of motor or sensory impairment.

Answer 12

apraxia

Question 13

How is cervical spondylotic myelopathy diagnosed?

Answer 13

• MRI
• CT scan
• EMG

Question 14

Why is an EMG useful for diagnosis?

Answer 14

First, it rules out the possibility of ALS. And it also provides information regarding the presence and degree of anterior horn or spinal nerve damage

Question 15

Describe the deterioration process associated with cervical spondylotic myelopathy

Answer 15

It can be…

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

Question 16

How is cervical spondylotic myelopathy treated conservatively?

Answer 16

• Neck immobilization
• Restriction of high-risk activities and environments
• Pain management in the form of NSAIDS, other analgesics, muscle relaxants, and/or antidepressant medications

Question 17

If conservative treatment does not work, what is the next step?

Answer 17

surgical decompression

Question 18

Surgical complications occur in up to __% of cervical spondylotic myelopathy patients

Answer 18

16

Question 19

A common surgical complication is nerve injury to which 2 cervical nerves?

Answer 19

C5 or C6