Cervical myelopathy

Last updated: August 2, 2022

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Cervical myelopathy is a type of myelopathy that is caused by axonal injury of the cervical spinal cord, either by direct compression or ischemic injury due to compression of the anterior spinal artery. The most common cause is cervical spondylotic myelopathy. Other etiologies include spinal trauma, neoplasms, epidural abscess, and autoimmune disorders. Onset can be acute, insidious, or progress in a stepwise fashion. Clinical features include neck pain and stiffness, impaired sensation in the hands and arms, weakness, poor manual dexterity, and gait instability. The diagnosis is confirmed by MRI. Treatment includes conservative management for mild disease without functional impairment or surgical decompression in acute or severe disease with functional impairment.

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Features depend on the level of compression and the onset may be sudden (e.g., with trauma), step-wise, or slowly progressive (e.g., degenerative diseases)

Damage to the spinal cord and the nerve roots (radiculopathy) often occur simultaneously!

Pain is not commonly an early symptom. Therefore patients may not be diagnosed until myelopathy becomes severe!

References:[1][3]

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The differential diagnoses listed here are not exhaustive.

Acute cervical myelopathy with loss of bladder and bowel control is a neurological emergency that demands immediate surgical decompression!

References:[3][5]

  1. Focus On: Cervical Myelopathy. http://hudsonspine.com/wp-content/uploads/2016/10/Cervical-Myelopathy-10-26-2016.pdf. Updated: January 1, 2012. Accessed: June 12, 2018.
  2. Baron EM, Young WF. Cervical spondylotic myelopathy. Neurosurgery. 2007; 60 (suppl_1): p.S1-35-S1-41. doi: 10.1227/01.neu.0000215383.64386.82 . | Open in Read by QxMD
  3. Agabegi SS, Agabegi ED. Step-Up To Medicine. Wolters Kluwer Health ; 2015
  4. Ford B. MKSAP 16: Neurology. American College of Physicians ; 2012
  5. Cervical Myelopathy. https://www.orthobullets.com/spine/2031/cervical-myelopathy. . Accessed: June 12, 2018.
  6. Levin, K.. Cervical spondylotic myelopathy. In: Post TW, ed. UpToDate. Waltham, MA: UpToDate. https://www.uptodate.com/contents/cervical-spondylotic-myelopathy.Last updated: February 5, 2019. Accessed: February 27, 2019.

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