Cervical Myelopathy

FACTS

HPI

neck pain
numb/clumsy hands
gait changes
Also summed up well in:
mJOA

PHYSICAL EXAM

complete spine exam
  • Lhermitte sign
  • walk the patient, evaluate their gait
  • evaluate for decreaesed LE reflexes

IMAGING

  • evaluate vertebral arteries
A/P
If operative:
  • CT C-spine/CTA neck for planning
  • MRI C-spine w/o contrast
 
notion image
Figure 1: R central disc herniation causing severe stenosis (not even a thin rind of CSF seen)
Figure 1: R central disc herniation causing severe stenosis (not even a thin rind of CSF seen)
 
Figure 2: C4-5 broad-based disc bulge with moderate spinal stenosis but with T2 cord signal change.
Figure 2: C4-5 broad-based disc bulge with moderate spinal stenosis but with T2 cord signal change.
Figure 3: T2 sagittal (left) and axial (right) demonstrating multi-level cervical stenosis worse at C3-4 (left)
Figure 3: T2 sagittal (left) and axial (right) demonstrating multi-level cervical stenosis worse at C3-4 (left)