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Vimukthi Chandula

Cervical myelopathy




Cervical myelopathy results from compression on the spinal cord.

The gradual degeneration of the spine (spinal stenosis) is resulting the narrowing of the spinal canal in the neck.

It is the most common disorder of the spinal cord in persons older than 55 years of age.


The causes of cervical myelopathy can be divided into different categories.


Static factor

  • A narrowing of the spinal canal size commonly resulting from degenerative change in the cervical spine.

  • Patients with a congenitally narrow spinal canal have a higher risk for development of symptomatic cervical myelopathy.

  • Chronic cervical degeneration is the most common cause of progressive spinal cord and nerve root compression.


Dynamic factors

  • It is due to mechanical abnormalities of the cervical spine or instability.


Vascular and cellular factors

  • Spinal cord ischemia affects oligodendrocytes, which results in demyelination exhibiting features of chronic degenerative disorders.

  • Cord compression is thought to be a combination of static compression and intermittent dynamic compression from cervical motion.(flexion,extension)


Due to cervical myelopathy,

Cervical myelopathy can cause a variety of signs and symptoms.

  • Cervical spondylotic myelopathy frequently involve compression of the lateral corticospinal tracts (voluntary skeletal muscle control), and the spinocerebellar tracts (proprioception).

It causes the wide-based-spastic gait with clumsy upper extremity function.

  • Ossification of the ligaments surrounding the spinal cord, such as posterior longitudinal ligament and ligamentum flavum.

  • Weakness and numbness occur in non-specific pattern.

  • Additional clinical presentations are neck pain and stiffness (Decrease ROM) shoulder and scapula pain, paresthaesia in one or both arms or hands, Babinski and Hoffman’s sign, ataxia and dexterity loss.

  • Exaggerated tendon reflex (patella and Achilles),presence of pathological reflexes (eg: clonus, Babinski and Hoffman’s sign),spastic quadriplegia sensory and bladder-bowel disturbance, bowel or bladder dysfunction and general weakness.


Other causes

  • Rheumatoid arthritis of the neck

  • Whiplash injury or other cervical spine trauma

  • Spinal infection

  • Spinal tumors and cancers


Symptoms

  • ️ Distal limb weakness

  • ️ Decrease ROM in the cervical spine, especially extension

  • ️ Clumsy or weak hands with difficulty in fine motor movements.

  • ️ Pain in shoulder or arms

  • ️ Unsteady or clumsy gait

  • ️ Increase reflexes in the lower extremities and in the upper extremities below the level of the lesion

  • ️ Numbness and paresthesia in one or both hands

  • ️ Radioculopathy signs


Physiotherapy Management

The goals of physiotherapy treatment under a qualified physiotherapist are pain relief, to improve function, to prevent neurological deterioration, to reverse or improve neurological deficits.


References

https://www.hopkinsmedicine.org/health/conditions-and-diseases/cervical-myelopathy


Chathumini Gunarathne



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