Degenerative Cervical Myelopathy

Question 1

What is degenerative cervical myelopathy (DCM)?

Answer 1

Degenerative compression of the cervical spinal cord resulting in functional impairment

Question 2

What are the risk factors for DCM?

Answer 2

Smoking
Genetics
Occupation (high axial loading)

Question 3

What are the symptoms of DCM?

Answer 3

Can be variable day-day

Pain (affecting neck, upper or lower limbs)
Loss of motor function (loss of digital dexterity, fork, shirt buttons - arm or leg weakness/stiffness leading to impaired gait and imbalance)
Numbness
Urinary/Faecal incontinence and/or impotence
Hoffman’s sign (flicking one finger causes twitch in others)

(Can present similarly to carpal tunnel syndrome)

Question 4

What is the investigation for DCM?

Answer 4

MRI cervical spine

Question 5

What are the findings on MRI in DCM?

Answer 5

Disc degeneration
Ligament hypertrophy
Cord signal change

Question 6

What is the treatment for DCM?

Answer 6

Urgent referral - early treatment important, surgery within 6 months of diagnosis best chance of recovery

Decompressive surgery

Close observation may be possible for mild, stable disease.