The clinical presentation of patients with cervical spondylosis with stenosis and spinal cord compression can be varied. The anterior syndrome, consisting of painless weakness in the upper extremities without accompanying symptoms of the lower extremities, is the fifth type of cervical myelopathy. A fourth syndrome, vascular cervical radiculopathy, may not show any clear pattern and is thought to result from spinal cord ischemia. Most commonly however, the clinical picture has elements of both lateral and medial types and is referred to as combined cervical myelopathy (the third type). The second, medial cervical myelopathy, is characterized by long tract symptoms and frequently spares the upper limbs as these nerve fibers are usually located further from the midline. The first, lateral cervical myelopathy, is characterized by predominantly nerve root symptoms (e.g.: radicular pain or unilateral neurological deficits). 9 All five types share either clinical symptoms or signs and radiographic evidence of compression of the spinal cord. ![]() 6 This myelopathy can be divided into five related syndromes based on the location of the pathology within the cervical spine (lateral, medial, combined, vascular and anterior). The inclusion of the term “spondylotic” into “cervical spondylotic” myelopathy reflects the fact that myelopathy, or dysfunction of the spinal cord, is often times associated with and caused by the normal osteoarthritic changes of the axial spine that accompany normal aging. Many patients and providers think that neck pain is a “normal” part of aging, but practitioner vigilance is key for identifying myelopathy and differentiating it from other causes of neck pain, including arthritis. The patient’s weakness improved post-operatively and her pain resolved. She underwent a C-6 corpectomy with discectomy at the C5-6 and C6-7 levels with cage and plate fixation to stabilize the spine (Fig. On review of these findings as well as the physical examination the patient was advised on anterior surgery. The axial view demonstrates flattening of the cervical cord. 1) demonstrated stenosis of the cervical spine at the C5-6 level due to a combination of disc herniation anteriorly and boney impingement posterior combining to narrow the canal. Sensation was diminished along the radial side of the forearm and thumb. Her finger flexors and abductors were rated 4/5. Her right bicep, wrist extensors and finger extensors were rated at -4/5. Pain radiated to the right shoulder and arm with extension movements of the neck. Movements of her neck were limited in flexion and extension. Physical examination demonstrated a well-developed 62-year-old female who was in mild distress due to right-sided neck pain and arm pain. Her medical illnesses included diabetes, asthma and hypertension. Four weeks prior to presentation the patient began to experience neck pain with radiation to the right arm and hand. The weakness was progressive and then was accompanied by numbness and tingling of the right hand. She first noted weakness with opening a jar and then it progressed to difficulty with writing. There was no history of trauma or lifting. The weakness began six months prior to presentation and was initially localized to the right arm. ![]() CASE STUDYĪ 62-year-old female presented with the chief complaint of right upper extremity weakness and pain. ![]() This article reviews the current trends in the diagnosis and treatment of cervical myelopathy as well as the classification of disability in patients who have treatment. Even with surgery, results are unpredictable and neurologic disability continues. Some patients remain static in their symptoms while others develop progressive disability requiring surgery. Cervical degeneration may lead to cervical stenosis, which can cause progressive neurologic impairment. Degeneration of the disks and vertebral bodies is a common finding MRI detected cervical lesions affect the spinal cord in 26 percent of asymptomatic older patients. Diseases of the spine have become more common because of the aging population.
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