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cervical myelopathy

Etiology: - disc herniation - hypertrophy of the ligamentum flavus - ossification of the longitudinal ligament - spinal cord neoplasm - cervical spondylosis - congenital anomaly Clinical manifestations: - patients present with signs & symptoms of cervical spinal cord dysfunction with or without cervical radiculopathy - neck pain, shoulder pain &/or pain in upper limbs may occur - loss of manual dexterity - gait & balance disturbances, sensory ataxia - increase tone & heaviness in lower extremities - Romberg's sign, Babinski's sign - Lhermitte sign may be present (electric shock sensation with neck flexion) - sensory loss in the hands or feet - arm or hand weakness - fecal or urinary frequency, urinary urgency, or urinary hesitancy - upper-motor-neuron signs [5] - hyperactive deep tendon reflexes Radiology: - magnetic resonance imaging (MRI) of the cervical spine Differential diagnosis: - vitamin B12 deficiency - hyperactive deep tendon reflexes uncommon - neck pain not a feature - serum vitamin B12 close to or below upper limit of reference interval & serum methyl-malonate is low Management: - surgical decompression improves neurologic function in some patients & prevents worsening in others - age is an independent predictor of surgical outcome - adults > 65 years of age do not have as much improvement in functional status after surgery as younger patients, but report similar quality-of-life improvements [3]

Specific

cervical spinal stenosis cervical spondylotic myelopathy; cervical spondylomyelopathy

General

spinal cord disease; myelopathy (disease/disorder primarily affecting spinal cord)

References

  1. Medical Knowledge Self Assessment Program (MKSAP) 16, 19. American College of Physicians, Philadelphia 2012, 2021 - Medical Knowledge Self Assessment Program (MKSAP) 20 American College of Physicians, Philadelphia 2025
  2. Geriatric Review Syllabus, 8th edition (GRS8) Durso SC and Sullivan GN (eds) American Geriatrics Society, 2013
  3. Nakashima H et al. Does age affect surgical outcomes in patients with degenerative cervical myelopathy? Results from the prospective multicenter AOSpine International study on 479 patients. J Neurol Neurosurg Psychiatry 2015 Sep 29 PMID: 26420885
  4. Rhee JM, Shamji MF, Erwin WM Nonoperative management of cervical myelopathy: a systematic review. Spine (Phila Pa 1976). 2013 Oct 15;38(22 Suppl 1):S55-67. Review. PMID: 23963006
  5. Rothaus C Cervical Spondylosis NEJM Resident 360. July 8, 2020 https://resident360.nejm.org/clinical-pearls/cervical-spondylosis
  6. NEJM Knowledge+ Question of the Week. August 18, 2020 https://knowledgeplus.nejm.org/question-of-week/1752/ - Walters BC et al. Guidelines for the management of acute cervical spine and spinal cord injuries: 2013 update. Neurosurgery 2013 Aug; 60:82 PMID: 23839357
  7. Kane SF, Abadie KV, Willson A. Degenerative cervical myelopathy: recognition and management. Am Fam Physician. 2020;102:740-750. PMID: 33320508
  8. Funaba M et al. The utility of a prediction model using neurological examination findings for diagnosing degenerative cervical myelopathy. J Bone Joint Surg Am 2025 Aug 20; 107:1867. PMID: 40638695
  9. McCormick JR, Sama AJ, Schiller NC, et al. Cervical spondylotic myelopathy: a guide to diagnosis and management. J Am Board Fam Med. 2020;33:303-313. PMID: 32179614