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Myelopathy M47.10 721.91

Upper Extremity innervation

Lower extremity Cutaneous Innervation

Spinal Cord Anatomy

synonyms:

Myelopathy ICD-10

Myelopathy ICD-9

  • 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 Anatomy

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.
    -Clonus

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
  • Myelopathy
  • 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)
  • Dysphagia
  • Dysphonia
  • Vertebral artery injury
  • Pseudoarthrosis
  • Adjacent segment degeneration

Myelopathy Follow-up Care

Myelopathy Review References

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