Cervical stenosis with myelopathy is a degenerative condition that pinches the spinal cord. Symptoms of cervical spinal stenosis vary and most often occur in elderly patients. If symptoms of cervical stenosis with myelopathy are not addressed early on, more severe symptoms may arise such as incontinence and paralysis. Myelopathy describes any neurologic deficit related to the spinal cord. When due to trauma, it is known as (acute) spinal cord injury. When inflammatory, it is known as myelitis. Cervical having to do with the spine in the neck Spondylotic having to do with spinal degeneration myelopathy damage to the spinal cord. Cervical spondylotic myelopathy is damage to the spinal cord in the neck. Cervical spondylotic myelopathy (CSM) is a neck condition that occurs when the spinal cord becomes compressed—or squeezed—due to the wear-and-tear changes that occur in the spine as we age. Cervical myelopathy refers to compression on the cervical spinal cord. Any space occupying lesion within the cervical spine with the potential to compress the spinal cord can cause clinic cervical cervical myelopathy is predominantly due to pressure on the anterior spinal cord with ischaemia as a result of deformation. Cervical myelopathy is the most common type of myelopathy. Learn more about this condition and its symptoms, causes and treatment options. Cervical stenosis means that there is narrowing in the spine in the neck (cervical) area.
Cervical myelopathy - physiopedia
On physical exam he is unable to perform a tandem gait and has a positive hoffman's sign bilaterally, however he has no clonus and a down-going babinski bilaterally. He has 4/5 strength in his hands, but 5/5 strength in all other muscle groups. Figure a is a sagittal mri. Figures b and c are an axial mri cuts through C4/5 and C5/6, respectively. What is the appropriate next step? Review Topic qid: 1312 decollete figures: 1 Observation 1 (9/1529) 2 Epidural injection 1 (10/1529) 3 Physical therapy and anti-inflammatory medication 4 (59/1529) 4 Anterior cervical diskectomy and fusion 86 (1308/1529) 5 Posterior cervical laminotomy-foraminotomy 9 (137/1529) Select Answer to see preferred Response thuis preferred response.
Improvement following a course of high-dose iv spinal steroids. 0 (7/1842) 3 Improvement following a period of rest, physical therapy, and oral medication. 1 (19/1842) 4 Slow progression in a pattern of stepwise deterioration following periods of stable symptoms. 89 (1644/1842) 5 Rapid and serious deterioration requiring urgent surgical treatment. 8 (151/1842) Select Answer to see preferred Response preferred response 4 (OBQ04.205) A 35-year-old man complains of clumsiness when buttoning his shirt and frequent episodes of falling when ambulating. Further work-up reveals congenital cervical spinal stenosis with spinal cord compression. Because of his young age, posterior laminoplasty is performed. Which nerve root is most likely to be adversely affected following surgery? Review Topic qid: 1310 1 C2 3 (48/1877) 2 C3 1 (26/1877) 3 C4 3 (49/1877) 4 C5 84 (1568/1877) 5 C6 10 (179/1877) Select Answer to see preferred Response preferred response 4 (OBQ04.207) A 45-year-old man presents to your office with difficulty ambulating and. It started two years ago but has worsened significantly over the last year.
Cervical Spondylotic myelopathy (CSM) - spinal Cord
A lumbar mri is shown in Figure. Review Topic qid: 706 figures: 1 Lumbar decompression only 1 (15/2091) 2 Lumbar decompression and instrumented fusion 16 (326/2091) 3 Discogram 0 (1/2091) 4 mri of the cervical spine 82 (1719/2091) 5 Lumbar epidural injection 1 (21/2091) Select Answer to see preferred Response preferred response. A t2-weighted mri scan is shown in Figure. Review Topic qid: 841 figures: 1 C4 to C7 cervical laminectomy 1 (29/2013) 2 C4 to C7 cervical laminectomy with fusion 23 (459/2013) 3 C4 to C7 laminoplasty with plate fixation 3 (63/2013) 4 Multilevel anterior cervical decompression with fusion and stabilization 72 (1450/2013). Review Topic qid: 850 1 Increased Central Motor Conduction Time (cmct) 3 (29/886) 2 Transverse area of the spinal cord 70mm2 62 (550/886) 3 Isolated low intramedullary signal on T1WI 4 (39/886) 4 A midsagittal diameter of the spinal canal of 13mm 3 (24/886). One potential mechanism of nerve root injury is thought to be tethering of the nerve root with dorsal migration of the spinal cord. What is the most common radicular pattern seen with this condition? Review Topic qid: 978 1 Motor-dominant radiculopathy with weakness of the deltoid 65 (939/1443) vrouwen 2 Sensory-dominant radiculopathy with pain in the lateral shoulder 19 (267/1443) 3 Motor-dominant radiculopathy with weakness of the wrist extensors 8 (109/1443) 4 Sensory-dominant radiculopathy with pain in the lateral forearm. Review Topic qid: 1098 1 Nurick 44 (443/1000) 2 Japanese anti Orthopaedic Association 10 (101/1000) 3 Modified Japanese Orthopaedic Association 14 (137/1000) 4 Ranawat 23 (234/1000) 5 Oswestry 8 (84/1000) Select Answer to see preferred Response preferred response 1 (OBQ04.61) A 66-year-old male presents with neck. On physical examination he has 5 of 5 motor strength in all muscles groups in his upper and lower extremities, a bilateral Hoffman sign, bilateral 3 patellar reflexes, 3 beats of clonus on the right, and no clonus on the left. Radiographs show segmental kyphosis of 12 degrees from C4.
Review Topic qid: 3256 1 Multi-level stenosis 6 (173/2898) 2 Duration of symptoms 14 (411/2898) 3 Local kyphosis angle 13 degrees 76 (2188/2898) 4 Osteoporosis 2 (49/2898) 5 mri finding of csf effacement 2 (66/2898) Select Answer to see preferred Response preferred response 3 (OBQ09.253). In which of these patients would a cervical laminoplasty alone be contraindicated as surgical treatment? Review Topic qid: 3366 figures: d e 1 Figure a 1 (21/1822) 2 Figure b 3 (57/1822) 3 Figure c 5 (97/1822) 4 Figure d 88 (1596/1822) 5 Figure e 2 (42/1822) Select Answer to see preferred Response preferred response 4 (OBQ08.106) Following a c3-C7. Sagittal T2 mri images are shown in Figures a and. What is the most appropriate surgical management? Review Topic qid: 517 figures: 1 Posterior foraminotomy 1 (11/2191) 2 Anterior decompression and fusion 82 (1792/2191) 3 Laminectomy alone 2 (44/2191) 4 Laminectomy and fusion 13 (293/2191) 5 Hinge-door laminoplasty 2 (46/2191) Select Answer to see preferred Response preferred response 2 (OBQ07.45) A 67-year-old. She prefers to stoop over the shopping cart whenever shopping. She recently noticed difficulty picking up small objects and buttoning her shirt. Physical exam shows normal strength in her lower extremities, and 3 bilateral patellar reflexes. Gait examination shows a broad, unsteady gait. Flexion and extension radiographs of the lumbar spine are shown in Figure a and.
Cervical Spondylotic myelopathy - the Spine hospital at TheReview Topic qid: 4607 1 reassurance and period of observation 0 (4/1978) 2 Night splinting in cock-up wrist splints 0 (5/1978) 3 Carpal tunnel corticosteroid injection 0 (7/1978) 4 Electromyographic studies of the upper extremities 2 (49/1978) 5 Cervical Spine mri 97 (1909/1978) Select Answer. On exam, she has 5/5 motor strength throughout bilateral upper and lower extremities. She has a normal gait and no difficulties with manual dexterity. Reflex testing shows hyperreflexia in bilateral Achilles tendons. Lateral radiographs are shown in Figure a, and mri scan is shown in Figures b and. What is the most appropriate management? Review Topic qid: 3632 figures: 1 C4-7 anterior decompression with instrumented mellékhatásai fusion 11 (255/2420) 2 C4-7 posterior decompression with instrumented fusion 7 (174/2420) 3 C4-7 posterior decompression without fusion 2 (37/2420) 4 C5/6 anterior discectomy and fusion 20 (486/2420) 5 Physical therapy 60 (1459/2420) Select. Six months ago she was able to walk with a cane, but now has difficulty with ambulating with a walker. She also reports difficulty with her hands and needs assistance with eating. Physical exam shows limited neck extension. Radiographs, tomography, and magnetic-resonance-imaging are shown in Figure a, b, and C respectively. Review Topic qid: 3674 figures: 1 nsaids, physical therapy, and clinical observation 1 (47/4104) 2 C3 to C6 cervical laminectomy 0 (15/4104) 3 C3 to C6 laminoplasty using an open-door technique 1 (46/4104) 4 C3 to C6 decompressive laminectomy with instrumented fusion 14 (576/4104).
Physical exam shows 5/5 strength in all muscles groups in the lower extremity. Figure v shows a shop result of forced ankle dorsiflexion on physical exam. A lumbar myelogram is performed and shown in Figure a, b, and. What is the most appropriate next step in treatment. Review Topic qid: 4534 figures: c 1 Lumbar decompression 5 overwerken (164/2982) 2 Lumbar decompression with arthrodesis 29 (859/2982) 3 A trial of physical therapy and nsaids 9 (278/2982) 4 Lumbar epidural steroid injections 2 (56/2982) 5 ct myelogram of cervical spine 53 (1587/2982) Select Answer. She complaints of difficulty with buttoning her shirt. On physical exam she is unable to preform a tandem gait. The strength in her upper extremities proximally is graded a 4/5, but she has significant bilateral intrinsic hand weakness and a positive hoffmann's sign. When told to hold her fingers in an extended and adducted position, her ring and small fingers flex and abduct within 20 seconds. What is the most appropriate next step in management?
Symptoms of Cervical Stenosis with myelopathy - spine-health
His physical exam is notable for exaggerated patellar reflexes and sustained clonus. The provocative maneuver shown in Figure v would most likely produce which of the following symptoms or physical exam finding? Review Topic qid: 3703 figures: 1 Electric shock-like sensations that radiate down the spine and into the extremities 91 (3454/3783) 2 Involuntary contraction of the thumb ip joint 2 (60/3783) 3 Spontaneously abduction of the 5th digit 2 (68/3783) 4 Spontaneously extension of the great. On physical exam she is unable to perform a tandem gait, has positive hoffmans signs bilaterally, and has 3 patellar reflexes. She has 5/5 strength in all her major muscle groups. Figure a is her mid sagittal mri. Figure b, c and d are axial images at C4/5, C5/6 and C6/7 respectively. What is the most appropriate treatment? Review Topic qid: 3714 figures: d 1 Physical therapy and close observation 1 (43/3633) 2 Physical therapy, an epidural steroid injection and evaluation after the injection 2 (71/3633) 3 C5/6 and C6/7 Anterior Cervical Discectomy and Fusion 92 (3341/3633) 4 C5, C6 and C7 posterior. Her lower extremity symptoms are severe enough that she reports laten she feels "unstable" on her feet.
Myelopathic patients may struggle to do this sensory proprioception dysfunction due to dorsal column involvement occurs in advanced disease associated with a poor prognosis decreased pain sensation pinprick testing should be done to look for global decrease in sensation or dermatomal changes due to involvement. Nerve conduction studies high false negative rate may be useful to distinguish peripheral from central process (ALS) Differential Normal aging mild symptoms of myelopathy often confused with a "normal aging" process Stroke movement disorders Vitamin B12 deficiency Amyotrophic lateral sclerosis (ALS) Multiple sclerosis Treatment Nonoperative. Things to consider include number of stenotic levels sagittal alignment of the spine degree of existing motion and desire to maintain medical comorbidities (eg, dysphasia) simplified treatment algorithm Anterior Decompression and Fusion (acdf) alone indications mainstay of treatment in most patients with single or two level. Fixation anterior plating functions to increase fusion rates and preserve position of interbody cage or strut graft pros cons advantages compared to posterior approach lower infection rate less blood loss less postoperative pain disadvantages avoid in patients with poor swallowing function Laminectomy with posterior fusion indications. Average.4 of 75 Ratings Technique guides (2) questions (40) (OBQ13.181) An 80-year-old man complains of neck pain and worsening upper extremity weakness after striking his forehead during a fall. For the last 2 years, he has been using a walker because of frequent falls, and no longer wears dress shirts because of difficulty with buttons. Examination reveals a positive finger-escape sign, and he is unable to make a fist and release 10 times in 10 seconds. Distal lower extremity muscle groups are stronger than proximal muscle groups. There is no instability on flexion-extension radiographs. An mri image is shown in Figure. Which of the following is the most appropriate treatment of the options listed? Review Topic qid: 4816 figures: 1 gait training 4 (125/2998) 2 mri of the lumbar spine 10 (308/2998) 3 C4 corpectomy and instrumented fusion 7 (218/2998) 4 C4 and C5 corpectomy and anterior instrumented fusion 29 (881/2998) 5 Laminoplasty 47 (1422/2998) Select Answer to see.
Cervical Stenosis with myelopathy - spine-health
Introduction, a clinical syndrome caused by compression on the spinal cord that is characterized by clumsiness in hands gait imbalance, pathophysiology etiology degenerative cervical spondylosis (CSM) most common cause of cervical myelopathy compression usually caused by anterior degenerative changes (osteophytes, discosteophyte complex) degenerative spondylolisthesis and. Opll tumor epidural abscess trauma cervical kyphosis neurologic injury mechanism of injury can be direct cord compression ischemic injury secondary to compression of anterior spinal artery. Associated conditions lumbar spinal stenosis tandem stenosis occurs in lumbar and cervical spine in 20 of patients. Prognosis natural history tends to be slowly progressive and rarely improves with nonoperative modalities progression characterized by steplike deterioration with periods of stable symptoms prognosis early recognition and treatment prior to spinal cord damage is critical for good clinical outcomes. Classification of myelopathy, nurick Classification, grade 0, root symptoms only or normal. Grade 1, signs of cord compression; normal gait. Grade 2, gait difficulties but fully employed, grade. Gait difficulties prevent employment, walks unassisted. Grade 4, unable to walk without assistance, grade. Wheelchair or bedbound, based on gait and ambulatory function. Ranawat Classification, class i, pain, no neurologic deficit, class. Subjective weakness, hyperreflexia, dyssthesias, banksparen class iiia objective weakness, long tract signs, ambulatory Class iiib objective weakness, long tract signs, non-ambulatory japanese Orthopaedic Association Classification A point scoring system (17 total) based on function in the following categories upper extremity motor function lower extremity motor function.