Cervical Myelopathy: Compression of the central spinal cord (central canal stenosis).
- Diff w/ Cervical Radiculopathy: Compression of an isolated spinal nerve root (neural foraminal stenosis, lateral disc herniation).

Epidemiology & Risk Factors

Most common cause of spinal cord dysfunction in patients >55 yo.
Etiology: Cervical spondylosis (degenerative disc disease, facet arthropathy, osteophytes), OPLL, congenital canal stenosis, rheumatoid arthritis w/ atlantoaxial subluxation. c
Pathophysiology: Extrinsic spinal cord compression in the cervical spine leading to ischemia, mechanical damage, and cord parenchymal injury.

Clinical Features

LMN signs at lesion level (Upper Extremities): Hand weakness, wasting of intrinsic hand muscles, lost fine motor dexterity (difficulty buttoning shirt), hyporeflexia.
UMN signs below lesion level (Lower Extremities): Spastic/ataxic broad-based gait, leg stiffness/weakness, hyperreflexia, (+) Babinski.
Painless sensory deficits in hands or feet
High-Yield Signs:
- Hoffmann sign: Flicking distal phalanx of middle finger produces involuntary flexion/adduction of thumb and index finger.
- Lhermitte sign: Flexion of the neck causes an electric shock-like sensation radiating down the spine into the limbs.
- Inverted brachioradialis reflex (wrist/finger flexion on percussion).
- Bowel/bladder dysfunction (late finding).

Initial / Screening: Cervical spine X-ray (shows degenerative changes/instability; cord not seen).
Confirmatory / Gold Standard: Cervical spine MRI (demonstrates cord compression and intrinsic T2 cord hyperintensity / myelomalacia).
MRI Contraindicated: CT myelography.

ALS: Combined UMN + LMN signs; lacks sensory deficits and bowel/bladder signs; features bulbar symptoms (dysarthria/dysphagia).
Normal Pressure Hydrocephalus (NPH): Classic triad (“wobbly, wet, wacky”); no focal upper extremity LMN signs; ventricular enlargement on head CT/MRI.
Cervical Radiculopathy: Pure root/LMN deficits (dermatomal pain/numbness, focal weakness); no UMN signs (normal gait/plantar responses).
Subacute Combined Degeneration (B12 deficiency): Loss of vibration/proprioception; ↑ methylmalonic acid/low B12; lacks focal cervical LMN deficits.

Definitive / Moderate-to-Severe (First-Line): Urgent surgical decompression & stabilization (e.g., ACDF, posterior laminectomy/laminoplasty) to halt progression.
Mild / Non-Progressive (Conservative): Immobilization w/ cervical collar, physical therapy, NSAIDs, close serial neuro checks.

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