DPT 755_Myelopathy & UCI_Summer 23

What defines cervical myelopathy?

It is an upper motor neuron lesion due to pressure on the spinal cord, typically with insidious onset in patients over 45 years of age.

What are common causes of cervical myelopathy?

Causes include degenerative changes in the cervical spine such as disc degeneration, facet degeneration, osteophyte formation, foraminal canal narrowing, and posterior longitudinal ligament hypertrophy.

How is cervical myelopathy diagnosed?

Diagnosis is based on subjective symptoms, clinical signs during a physical examination, and MRI findings.

What are some common symptoms of cervical myelopathy?

Symptoms include radicular pain, a wide-based gait, numbness/tingling in lower extremities, neck/shoulder pain stiffness, loss of fine motor control, and Lhermitte’s sign.

What are the signs of an upper motor neuron lesion?

Signs include spasticity, hyper-reflexia, absence of muscle atrophy, and positive pathological reflexes like Babinski sign.

What is the significance of a positive Hoffman's test in cervical myelopathy?

A positive Hoffman's test is one of the cluster items indicating cervical myelopathy along with gait deviation and other signs.

How do you manage cervical myelopathy?

depends on the severity of symptoms, surgery for severe spinal cord compression, referral if symptoms are progressing rapidly or new

What are risk factors for upper cervical instability?

Risk factors include history of trauma, congenital collagenous compromise, throat infections, inflammatory arthritis, recent surgeries, and conditions like Os Odontoideum.

List some common signs and symptoms of upper cervical instability.

Signs and symptoms include occipital headaches, severe limitations in neck AROM, signs of cervical myelopathy, inability to tolerate static head positions, and 'clunking' sounds with certain neck motions.

What is the primary method for diagnosing upper cervical instability?

Diagnosis is primarily based on the patient's history and imaging studies such as x-rays and MRI.

What physical therapy exam tests can you perform to diagnose upper cervical instability?

Sharp-Purser test, alar ligament test, transverse ligament test

What role do the Canadian C-Spine Rules play in managing cervical spine injuries?

They help determine which patients do not need x-rays based on high-risk factors and allow for clinical clearance if low-risk factors are present. high sensitivity

Canadian C-spine rules for cervical spine radiography in alert and stable trauma patients

65 or older, paresthesia in extremities, dangerous mechanism of injury, ability to assume sitting postions, non immediate neck pain,

What is the management strategy for acute upper cervical instability?

In acute presentations, the Canadian C-Spine Rule is used to decide on imaging referrals.

What is Lhermitte’s sign and its clinical significance in cervical myelopathy?

Lhermitte's sign is an electric shock sensation down the spine or arms with neck flexion/extension and indicates cervical myelopathy.

Patient presentation for an atlas or axis fracture

mechanism of injury, neck and occipital numbness, pain or stiffness in neck, reluctance to move, neurological symptoms