- 721.91 Spondylosis with myelopathy
Myelopathy Etiology / Epidemiology / Natural History
- Compression of the spinal cord from herniated disk, osteophytes, redundant ligamentum flavum, ossified PLL(more common in Asians)
Myelopathy Clinical Evaluation
- Clumsiness, los of coordination, loss of fine motor skills, stiff gait, balance disturbance, numbness/buring in hands/feet, urninary retention, incontinence (rare)
- Fine motor skills: tying shoes, buttoning buttons, handwriting
- Symptoms are often subtle.
- Upper and lower extremity NV exam.
- DTRs typically increased.
- Long Track signs indicate myelopathy
-Babinski's Reflex: upturning and splaying of the toes with plantar stimulus
-Hoffman's sign: flexion of the thumb and index fingers in response to flicking the tip of the outstretched middle finger
-Lhermitte's sign: shooting sensations down the arm with rapid neck flexion.
-Inverted Radial reflex: decreased brachioradialis reflex with concomitant flexion of all fingers.
Myelopathy Xray / Diagnositc Tests
- A/P, Lateral, Odontoid, flexion / extention lateral views. Evaluated for instability, pseudarthrosis, atlantoaxial arthrosis.
- MRI: typically reveals area of compression.
Myelopathy Classification / Treatment
- Due to risks fof progression and possibly irreversible neurologic deficits treatment is generally surgical dempression.
- Surgical Options: Laminectomy, laminoplasty, ACDF (anterior diskectomy and fusion) +/- corpectomy.
Myelopathy Associated Injuries / Differential Diagnosis
- Carpal tunnel syndrome
- Cubital tunnel syndrome
- Thoracic outlet syndrome
- Cauda Equina Syndrome
- Lumbar HNP
- Thoracic HNP
Myelopathy Complications (ACDF)
- Recurrent laryngeal nerve palsy (more common with right sided anterior approaches)
- Horner's syndrome (sympathetic chain neuropraxia)
- Vertebral artery injury
- Adjacent segment degeneration
Myelopathy Follow-up Care
Myelopathy Review References