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Diagnosing Cervical Myelopathy

Posted on: 12/21/2006
Doctors from the University of Wisconsin review a common problem with aging: cervical myelopathy (CM). Degenerative changes in the cervical spine (neck) can narrow the space for the spinal cord. Pressure on the spinal cord can produce a wide range of symptoms. This condition is referred to as CM.

The authors present a typical profile of the patient with CM: male, 50 years old or older, with neck pain that goes down the arm. Numbness, weakness, and clumsiness of the arms are common problems. Symptoms can occur below the belt, too. Loss of bladder control and leg weakness with gait changes (walking patterns) are also reported.

In this article, special tests and signs to help diagnose the problem are presented. Strength, sensory, and reflex testing are followed up by X-rays, nerve conduction tests, and electromyographic (EMG) tests. Normal and abnormal responses of nerve testing in the cervical spine are reviewed in detail.

There are many other conditions, diseases, and disorders that can present with the same or similar signs and symptoms as CM. The physician must rule out the presence of any of these other problems.

Multiple sclerosis, amyotropic lateral sclerosis (ALS or Lou Gehrig's disease), and Guillain-Barré syndrome are the most common neurologic conditions to mimic CM. Lyme disease, rheumatoid arthritis, post-polio, tumors, and pernicious anemia must also be considered. There is also a possibility that sensory and motor abnormalities are psychologic. Psychogenic disorders have a different treatment and management compared with true CM.

Doctors must rely on patient history, findings on exam, and the results of additional testing to identify the underlying cause of symptoms typical of cervical myelopathy. A delay in diagnosis is not uncommon given the vague nature of early CM symptoms. Knowing what to look for, what tests to conduct, and what the results may mean are important steps in the diagnostic process.

Frank J. Salvi, MD, MS, et al. The Assessment of Cervical Myelopathy. In The Spine Journal. November/December 2006. Vol. 6. No. 6S. Pp.182S-189S.

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