Today we will discuss a diagnosis that is not common, however it is very important to pick up on someone who presents with symptoms consistent with cervical myelopathy. Cervical Myelopathy (CM) results from compression of the spinal cord in the neck (cervical area of the spine). Symptoms of cervical myelopathy may include problems with fine motor skills, pain or stiffness in the neck, loss of balance, muscle weakness, increased muscle tone, difficulties with bowel and bladder habits, and trouble walking. MRI remains the Gold Standard for imaging in the diagnosis of CM.
If CM is left untreated it can cause severe pain, bowel and bladder dysfunction, nerve damage, difficulty walking and loss of balance, limited use of your fingers, hands, and arms, and left long enough, can cause paralysis.
An important point regarding CM is that symptoms are relatively permanent after surgical management as it is the spinal cord that is damaged. Our central nervous system (brain and spinal cord) do not regenerate, therefore when there is cord compression, this interrupts the tracts that rapidly carry the signals from our limbs to our brain (sensory) and from our brain to our limbs (motor). This is why having a proper diagnosis is very important, and as early as possible.
On assessment, your physiotherapist may find ‘upper motor neuron signs’ which refer to a constellation of symptoms that arise from damage to the upper motor neurons, which are part of the central nervous system that controls voluntary movement. These include muscle weakness, increased muscle tone, a positive Babinski (a test that indicates whether the upper motor neurons have been disrupted), and hyperactive reflexes. It is important to note that one of these symptoms does not in and of itself, provide a diagnosis of CM.
Appropriate referrals must be made in a timely fashion with CM, due to the permanence of the symptoms when a diagnosis of CM is made. True cord compression must be managed surgically in terms of a fusion of several segments depending on your presentation. In fusing the spine, the spinal cord is decompressed which results in regaining continuity of the long tracts in the spinal cord.