HWN Suggests

Time is Brain, Time is Testicle, Time is…Spine?

There is not a well-defined pattern of symptoms and neurologic deficits in cervical myelopathy. Patients experience a wide constellation of symptoms, which are typically insidious in onset, and often progress in a stepwise manner. Patients may experience neck pain, weakness or loss of dexterity of their upper extremities, paresthesias, and gait instability. Urinary retention appears late in disease progression. The textbook case might describe gait impairment with bilateral loss of hand dexterity and issues with activities such as buttoning a shirt, writing, or holding small objects.

read full article

Featured

 Degenerative Cervical Myelopathy

The diagnosis of DCM relies on a combination of clinical suspicion, a targeted physical examination, and imaging studies. Historically, a key feature of myelopathy is the evolution of symptoms over months, often involving neck pain/stiffness, limb/body pain, upper limb – weakness/numbness/loss of dexterity, lower limb – stiffness/weakness/sensory loss, paraesthesia, autonomic symptoms, imbalance, and falls. However, these symptoms can be non-specific and may overlap with age-related decline or other neurological conditions.

Articles of Interest

Cervical Myelopathy: Cervical Spinal Cord Compression

There are many things that can cause this, but one of the most common is cervical spondylotic myelopathy, which happens when the spine changes with age. This condition is more common in individuals over 50. The changes in the spine can cause disc herniations or growth in the ligaments in the back of the spine.

Cervical radiculopathy and cervical myelopathy: diagnosis and management in primary care

Cervical myelopathy is spinal cord dysfunction due to compression caused by narrowing of the spinal canal. Common causes include disc herniation, spondylosis, and congenital stenosis, often in combination. The compression causes upper and lower motor and sensory neurone symptoms of the arms and legs, and the onset is often insidious.

Cervical Stenosis with Myelopathy

Cervical spinal stenosis, also called cervical stenosis, occurs when the neck’s protective spinal canal narrows due to degenerative changes or trauma. If the space within the spinal canal is reduced too much, neurologic deficits can result from spinal cord compression, a condition called myelopathy.

Cervical Steroid Injections Are Not Effective for Prevention of Surgical Treatment of Degenerative Cervical Myelopathy

While cervical steroid injections continue to be commonly performed in patients with DCM, there is an overall increased odds of surgery after any type of cervical injection. Therefore injections should not be used to prevent surgical management of DCM.

Degenerative cervical myelopathy - Diagnosis and management in primary care

Degenerative cervical myelopathy (DCM) is the most common form of spinal cord dysfunction in adults. It occurs when age-related osteoarthritic changes cause narrowing of the cervical spinal canal, leading to chronic spinal cord compression and neurologic disability. Owing to the variability of clinical presentation, DCM can be very difficult to diagnose.

Degenerative Cervical Myelopathy: A Practical Approach to Diagnosis

DCM is an overarching term used to describe progressive compression of the cervical spinal cord by age-related changes to the spinal axis. These alterations to normal anatomy narrow the spinal canal, reduce the space available for the spinal cord, and may ultimately compress the ascending and descending neural tracts. Patients with DCM present with a wide range of symptoms that can significantly impact quality of life,

Improving time-to-diagnosis and treatment in degenerative cervical myelopathy: why interdisciplinary teamwork matters

Due to lack of awareness and challenges in the differential diagnosis, DCM is often misdiagnosed and therefore not treated in a timely fashion. In fact, the average time to diagnosis of DCM is 2.2±2.3 years, and patients attend an average of 5.2±3.6 physician visits before obtaining a correct diagnosis. This delay in diagnosis results in increased time to surgical management and undoubtedly affects functional and quality-of-life outcomes in these individuals.

Resources

StatPearls

Cervical myelopathy is a condition describing a compression of the spinal cord at the cervical level of the spinal column resulting in spasticity (sustained muscle contractions), hyperreflexia, pathologic reflexes, digit/hand clumsiness, and/or gait disturbance. Classically it has an insidious onset progressing in a stepwise manner with functional decline.