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Cervical Myelopathy

Questions

What is Cervical Myelopathy?

Cervical Myelopathy refers to compression at the cervical level of spinal cord, resulting in spasticity, hyperreflexia, digit/hand clumsiness, and gait disturbances. Cervical myelopathy is predominantly due to pressure on the anterior spinal cord with ischaemia as a result of deformation of the cord by anterior herniated discs, spondylitic spurs, an ossified posterior longitudinal ligament or spinal stenosis.

Cervical spondylotic myelopathy is the most common disorder of the spinal cord in persons older than 55 years of age. Both sexes are affected equally

Symptoms of Cervical Myelopathy

The symptoms usually develop slowly.

Early symptoms of this condition are ‘numb, clumsy, painful hands’ and disturbance of fine motor skills.

Weakness and numbness occur in a non-specific/non-dermatomal pattern.

·         Distal weakness

·         Decreased ROM in the cervical spine, especially extension.

·         Clumsy or weak hands

·         Pain in shoulder or arms

·         Unsteady or clumsy gait

·         Increased reflexes in the lower extremities and in the upper extremities below the level of the lesion.

·         Numbness and paresthesia in one or both hands

·         Radiculopathic signs

Causes of Cervical Myelopathy

 Degenerative cervical spondylosis.

·         Most common cause of cervical myelopathy.

·         Compression usually caused by anterior degenerative changes (osteophytes, discosteophyte complex). 

·         Degenerative spondylolisthesis and hypertrophy of ligamentum flavum may contribute.

·         Congenital stenosis.

·         Symptoms usually begin when congenital narrowing combined with spondylotic degenerative changes in older patients.

·         Tumor

·         Trauma

·         Cervical kyphosis

·         Neurologic injury

Diagnosis of Cervical Myelopathy

The diagnosis of CSM is primarily based on the clinical signs found on physical examination and is supported by imaging findings.

Examination: Combinations of three of five or four of five of these tests enable post-test probability of the condition to 94–99%:

1.      Gait deviation

2.      +ve Hoffmann’s test

3.      Inverted supinator sign

4.      +ve Babinski test

5.      age 45 years or older

These tests demonstrate low sensitivity and are not appropriate for ruling out myelopathy. One method used to improve the diagnostic accuracy of clinical testing is combining tests into clusters. These often overcome the inherent weakness of stand-alone tests.

Imaging: Plain radiographs alone are of little use as an initial diagnostic procedure. A magnetic resonance image (MRI) is considered the best imaging method for confirming the presence of spinal canal stenosis, cord compression, or myelomalacia, elements germane to cervical spine myelopathy. MRI of the cervical spine can also rule out spinal cord tumours.

Treatment of Cervical Myelopathy

Medical management: Patients with severe or disabling pain may  be helped with surgery. When myelopathy is caused by factors of a progressive nature, such as spinal cord tumors, surgical treatment is recommended.

The principal aim of surgery for cervical myelopathy is decompression of the spinal cord. Surgical techniques include multi-level discectomies or corpectomies with or without instrumented fusion, laminectomy with or without instrumented fusion or laminoplasty.

Physical therapy management: The goals of physiotherapy great are:

·        pain relief

·        to improve function

·        to prevent neurological deterioration

·        to reverse or improve neurological deficits.

Physical therapies imclude.:

·        Cervical traction and manipulation of thoracic spine.

·        Cervical stabilization exercises

·        Dynamic upper and lower limb exercises

·        Proprioceptive neuromuscular facilitation

·        Mobility and proprioceptive exercises

·        Core stability exercise.

·        Aerobic exercises

·        Balance training

·        Improve posture.

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