🔑 Key Learning

  • Cervical myelopathy is spinal cord compression in the cervical spine, usually from degenerative changes.
  • Presents with upper motor neuron (UMN) signs in the lower limbs and hand dysfunction (e.g. clumsiness, weakness).
  • MRI is the investigation of choice.
  • Requires urgent spinal referral for surgical decompression.

🧬 Pathophysiology

  • Caused by compression of the cervical spinal cord, often due to:
    • Cervical spondylosis (degenerative disc disease and osteophytes)
    • Herniated intervertebral disc
    • Ligamentum flavum hypertrophy
    • Ossification of the posterior longitudinal ligament
  • Results in impaired neural transmission, leading to UMN signs below the level of compression, and LMN signs at the level of the lesion (e.g. hand weakness).

👀 Clinical Features

Symptoms

  • Neck pain or stiffness
  • Clumsiness of the hands (e.g. dropping objects, difficulty with fine motor tasks like buttons or writing)
  • Gait disturbance or unsteadiness
  • Upper limb numbness or weakness
  • Urinary urgency, frequency or incontinence

Examination Findings

  • Upper motor neuron signs below the lesion:
    • Hyperreflexia
    • Spasticity
    • Positive Babinski sign
  • Hand dysfunction:
    • Weakness, reduced dexterity
    • Muscle wasting or atrophy (if lower motor neuron involvement at that level)
  • Positive Hoffmann’s sign: Flicking the distal phalanx of the middle finger causes involuntary thumb flexion
  • Lhermitte’s sign: Electric shock sensation down the spine or limbs on neck flexion

🧪 Investigations

  • MRI cervical spine: Gold standard
    • Reveals spinal cord compression and cord signal changes

💊 Management

  • Urgent referral to spinal surgery
    • Surgical decompression (e.g. anterior cervical discectomy and fusion or laminectomy) is the mainstay of treatment
    • Delay in treatment is associated with permanent neurological deficits

📝 Exam Clues & Clinchers

  • Middle-aged or older adult with clumsy hands, gait instability, and brisk reflexes in the legs
  • MRI is the gold standard
  • Always refer urgently – surgical decompression is required

   

Feature Cervical Radiculopathy Cervical Myelopathy
🧬 Pathophysiology Compression of a nerve root Compression of the spinal cord itself
🔍 Anatomy involved Exiting cervical nerve root (e.g. C6, C7) Cervical spinal cord (central canal stenosis)
👤 Typical patient Younger adults with disc herniation, or spondylosis Older adults with degenerative cervical stenosis
⚡ Symptoms Unilateral pain, tingling, numbness in a dermatome Bilateral symptoms, clumsy hands, gait disturbance
💪 Motor findings Weakness in specific myotome Weakness + spasticity below the level of compression
🦶 Reflexes Decreased reflexes at affected level (LMN signs) Hyperreflexia, positive Babinski, Hoffmann (UMN)
🧪 Special tests Positive Spurling’s test Positive Lhermitte’s sign, gait abnormalities
🔬 Diagnosis MRI cervical spine (nerve root compression) MRI cervical spine (cord compression, signal change)
💊 Management Often conservative; surgery if progressive Usually requires surgical decompression