Cervical Spondylotic Myeolpathy

Question 1

Spondylosis

Answer 1

Progressive degenerative process affecting the cervical bodies and IVDs

Question 2

Myelopathy

Answer 2

Caused by compression of the SC due to narrowing (stenosis) of central SC

Question 3

Cervical spondylotic myeolpathy

Answer 3

most common cause of myelopathy in adults over 55 y.o.

Question 4

Cervical spondylosis

Answer 4

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

Question 5

Injury to anterior horn cells causes what deficit

Answer 5

LMN deficits

Question 6

Pathophysiology

Answer 6

1. mechanical compression of neural elements
2. SC ischemia due to compression of the arterial and/or venous blood supply to the cord
3. flexion and extension of neck may exacerbate compression
4. Radiculomyelopathy

Question 7

Clinical Presentation

Answer 7

1. Pain, neck creptius
2. Numbness/paresthesia in arms - dermatomal pattern
3. Gait disturbance (eary symptom) - spastic scissoring quality
4. Sensory disturbance - reduced joint position/vibratory sense, loss of pain
5. UMN findings in lower extremities - inc. tone/reflex, weakness, + Babinski
6. LMN finding in myotomal distribution of arms/hands - weakness, atrophy, suppressed reflexes
7. Bladder dysfunction
8. Lhermitte’s sign
9. Acute presentation - due to fall, whiplash injury

Question 8

C5 region of pain

Answer 8

Neck, shoulder, scapula

Question 9

C5 region of numbness

Answer 9

Lateral arm (in distribution of axillary nerve)

Question 10

C5 weakness

Answer 10

Shoulder abduction, ER, elbow flexion, forearm supination

Question 11

C5 reflex affected

Answer 11

Biceps and brachioradialis

Question 12

C6 region of pain

Answer 12

Neck, shoulder, scapula, lateral arm, lateral forearm, lateral hand

Question 13

C6 region of numbness

Answer 13

Lateral forearm, thumb, and index finger

Question 14

C6 weak movements

Answer 14

Shoulder abduction, ER, elbow flexion, forearm supination/pronation

Question 15

C6 reflex affected

Answer 15

Biceps and brachioradialis

Question 16

C7 region of pain

Answer 16

Neck, shoulder, middle finger, hand

Question 17

C7 region of numbness

Answer 17

Index and middle finger, palm

Question 18

C7 weak movements

Answer 18

elbow and wrist extension (radial), forearm pronation, wrist flexion

Question 19

C7 reflex affected

Answer 19

Triceps

Question 20

C8 region of pain

Answer 20

neck, shoulder, medial forearm, fourth and fifth digits, medial hand

Question 21

C8 region of numbness

Answer 21

medial forearm, medial hand, fourth and fifth digits

Question 22

C8 weak movements

Answer 22

Finger extension, wrist extension (ulnar), distal finger flexion, extenion, abduction, and adduction, distal thumb flexion

Question 23

C8 reflex affected

Answer 23

NONE

Question 24

T1 region of pain

Answer 24

neck, medial arm and forearm

Question 25

T1 region of numbness

Answer 25

Anterior arm and medial forearm

Question 26

T1 weak movements

Answer 26

thumb abduction, distal thumb flexion, finger abduction and adduction

Question 27

T1 reflex affected

Answer 27

NONE

Question 28

Diagnosis of cervical spondylotic myelopathy

Answer 28

MRI/CT scan

EMG - could show info regarding presence/degree of ant. horn cell or spinal nerve route damage

Question 29

Prognosis of cervical spondylotic myelopathy

Answer 29

Natural history not well characterized

2. deterioration can be
   - Progessive
   - Slow and stepwise deterioration with long periods of stability
   - abrupt deterioration with minor neck injury

Question 30

Treatment of cervical spondylotic myelopathy

Answer 30

Conservative measures

1. neck immobilization
2. Restrict high risk activities/environments
3. pain management
   - NSAIDS, other analgesics
   - muscle relaxants
   - Antidepressant medications

Question 31

Treatment for acute myelopathy

Answer 31

1. Neurologic emergency
2. Immediate neuro-imaging
3. Prompt neurosurgical/orto consultation
4. high - dose IV corticosteroid

Question 32

ALS but not cervical spongy myelopathy

Answer 32

CN involvement and tongue fasciculation…. Both have muscle weakness and hyporeflexia