Cervical Spondylotic Myeolpathy Flashcards
Spondylosis
Progressive degenerative process affecting the cervical bodies and IVDs
Myelopathy
Caused by compression of the SC due to narrowing (stenosis) of central SC
Cervical spondylotic myeolpathy
most common cause of myelopathy in adults over 55 y.o.
Cervical spondylosis
disc herniation, osteophyte formation, hypertrophy of posterior longitudinal ligament and ligamenta flava
Injury to anterior horn cells causes what deficit
LMN deficits
Pathophysiology
- mechanical compression of neural elements
- SC ischemia due to compression of the arterial and/or venous blood supply to the cord
- flexion and extension of neck may exacerbate compression
- Radiculomyelopathy
Clinical Presentation
- Pain, neck creptius
- Numbness/paresthesia in arms - dermatomal pattern
- Gait disturbance (eary symptom) - spastic scissoring quality
- Sensory disturbance - reduced joint position/vibratory sense, loss of pain
- UMN findings in lower extremities - inc. tone/reflex, weakness, + Babinski
- LMN finding in myotomal distribution of arms/hands - weakness, atrophy, suppressed reflexes
- Bladder dysfunction
- Lhermitte’s sign
- Acute presentation - due to fall, whiplash injury
C5 region of pain
Neck, shoulder, scapula
C5 region of numbness
Lateral arm (in distribution of axillary nerve)
C5 weakness
Shoulder abduction, ER, elbow flexion, forearm supination
C5 reflex affected
Biceps and brachioradialis
C6 region of pain
Neck, shoulder, scapula, lateral arm, lateral forearm, lateral hand
C6 region of numbness
Lateral forearm, thumb, and index finger
C6 weak movements
Shoulder abduction, ER, elbow flexion, forearm supination/pronation
C6 reflex affected
Biceps and brachioradialis
C7 region of pain
Neck, shoulder, middle finger, hand
C7 region of numbness
Index and middle finger, palm
C7 weak movements
elbow and wrist extension (radial), forearm pronation, wrist flexion
C7 reflex affected
Triceps
C8 region of pain
neck, shoulder, medial forearm, fourth and fifth digits, medial hand
C8 region of numbness
medial forearm, medial hand, fourth and fifth digits
C8 weak movements
Finger extension, wrist extension (ulnar), distal finger flexion, extenion, abduction, and adduction, distal thumb flexion
C8 reflex affected
NONE
T1 region of pain
neck, medial arm and forearm
T1 region of numbness
Anterior arm and medial forearm
T1 weak movements
thumb abduction, distal thumb flexion, finger abduction and adduction
T1 reflex affected
NONE
Diagnosis of cervical spondylotic myelopathy
MRI/CT scan
EMG - could show info regarding presence/degree of ant. horn cell or spinal nerve route damage
Prognosis of cervical spondylotic myelopathy
Natural history not well characterized
- deterioration can be
- Progessive
- Slow and stepwise deterioration with long periods of stability
- abrupt deterioration with minor neck injury
Treatment of cervical spondylotic myelopathy
Conservative measures
- neck immobilization
- Restrict high risk activities/environments
- pain management
- NSAIDS, other analgesics
- muscle relaxants
- Antidepressant medications
Treatment for acute myelopathy
- Neurologic emergency
- Immediate neuro-imaging
- Prompt neurosurgical/orto consultation
- high - dose IV corticosteroid
ALS but not cervical spongy myelopathy
CN involvement and tongue fasciculation…. Both have muscle weakness and hyporeflexia
