Cervical cord compression can arise due to a number of conditions of various origins. Neck pain, limited range of neck motion, pain in the upper extremities, severe balance difficulties, incontinence, and paralysis may be seen in cervical cord compression. A thorough neurological examination is crucial for making the initial diagnosis. Imaging studies, magnetic resonance imaging (MRI) and computed tomography (CT), are frequently necessary to identify the underlying etiology.
Cervical cord compression is a term denoting a pathological process of the cervical spinal cord in which different pathological entities cause its compression. Cervical spondylotic myelopathy (CSM), a consequence of a degenerative process of the vertebrae and surrounding connective tissue that is primarily seen in elderly persons, is one of the most frequently mentioned causes   . The clinical presentation of cervical cord compression, particularly when CSM is the underlying culprit, can have an insidious course with early symptoms being mild neck stiffness and a limited range of neck motion, reduced hand dexterity, minor balance issues, clumsiness, and difficulties with performing easy tasks (handwriting, use of keys, holding the handrail while climbing up the stairs, or text messaging)   . It is not uncommon for patients to neglect early symptoms , but as the severity of compression increases more pronounced manifestations develop. Pain in the upper extremity, particularly the shoulder, either described as stabbing or dull can appear along with hand numbness   . Paresthesias and weakness eventually arise. A more severe form of cervical cord compression leads to inadequate sphincter control and paralysis  . In rare cases, lesion of the ascending spinothalamic tract might cause referred pain to the lower back or the lower extremities termed funicular leg pain .
Entire Body System
- Difficulty Walking
Spinal cord compression can cause neurologic symptoms—such as pain, numbness, or difficulty walking. Your spinal cord is the conduit that enables communication between your brain and body. [spineuniverse.com]
Cervical Cord Compression Symptoms Cervical cord compression symptoms may include heavy feeling in the arms and legs, cervical pain that is referred to the arm, shooting pains in the arms and legs, and/or difficulty walking and performing activities involving [emoryhealthcare.org]
Difficulty walking Loss of fine motor skills. Difficulty writing, buttoning your clothes, or handling a knife and fork. [directorthocare.com]
In other situations, cervical stenosis with myelopathy may present itself in symptoms that include a heavy feeling in the arms and legs, cervical pain that is referred to the arm, shooting pains in the arms and legs, and/or difficulty walking and performing [spine-health.com]
Cervical myelopathy is a syndrome of difficulty walking, hand clumsiness, arm weakness, and/or numbness/tingling caused by compression of the spinal cord. [uncmedicalcenter.org]
- Disproportionate Short Stature
Introduction Achondroplasia (OMIM 100800) is the most common disproportionate short stature skeletal dysplasia with an incidence of approximately 1 in 26,000 (ref. 1). [nature.com]
- Neck Pain
PATIENT CONCERNS: A 48-year-old female patient was presented to the Neurosurgical Department, complaining of progressive back neck pain with bilateral upper extremities numbness and weakness for 4 months. [ncbi.nlm.nih.gov]
The most common causes of neck pain are soft-tissue abnormalities due to injury or prolonged wear-and-tear. In rare instances, infection or tumors may cause neck pain. [shorelineortho.com]
Case Report: A 74-year-old woman presented to our emergency department with sudden onset of right neck pain when extending the neck. The pain mimicked an electric shock and radiated to the left shoulder. [tmu.pure.elsevier.com]
A 51-year-old woman presented to physical therapy with complaints of weakness in her left arm, progressive numbness in both hands, and mild progressive neck pain radiating into the left upper arm. [jospt.org]
- Spine Pain
Bending your neck forward (flexing) may cause electrical-like sensations that move down your spine. Pain may spread from your neck to your arms and fingers. [fixbones.com]
Changing your mattress can help ease some of your spine pain. Look for a mattress that is not too firm or too soft. The right mattress should help you to get a better night’s sleep and ease some of your neck and/or back pain. [verywellhealth.com]
- Stiffness of the Lower Limbs
Post operatively patient noticed significant improvement in stiffness in both lower limbs. Autologous fat graft is one of the best materials used in sealing the dural cerebrospinal fluid leak during spinal surgery. [ncbi.nlm.nih.gov]
- Atrophy of Hand Muscles
[…] of hand muscles Sensory involvement in various distributions in upper or lower extremities (always plurisegmental) Gait ataxia with positive Romberg sign. [onlinelibrary.wiley.com]
Achondroplasia results in disproportionate short stature, macrocephaly, and increased rates of obstructive and central sleep apnea as well as foramen magnum stenosis.2,3,4 Infants and children under 4 years of age with achondroplasia are at increased [nature.com]
Face, Head & Neck
Two patients did not show satisfactory improvement after the decompression of the entrapment lesions, and six patients had hyperreflexia of lower limbs. [ncbi.nlm.nih.gov]
Hyperreflexia. Heightened deep tendon reflexes in the knee and ankle are potential indicators of spinal cord compression and dysfunction. Clonus. Upon forcing the ankle to extend, the patient's foot rapidly beats up and down. Babinski reflex. [spine-health.com]
Symmetrical upper motor neurone signs were seen in both lower limbs, namely increased tone, globally reduced power (particularly in hip flexion), deep tendon hyperreflexia, and ankle clonus. Plantar reflexes were equivocal and sensation was intact. [bjgp.org]
Several findings indicative of an ongoing pathological process involving the cervical spinal cord are: Hyperreflexia - A brisk triceps reflex accompanied by the absence of biceps and supinator reflexes are considered to be pathognomonic findings of cervical [symptoma.com]
Subacute or chronic compression may begin with local back pain, often radiating down the distribution of a nerve root (radicular pain), and sometimes hyperreflexia and loss of sensation. Sensory loss may begin in the sacral segments. [msdmanuals.com]
- Long Tract Signs
RESULTS: Both the Chiari I and cervical compression groups had long tract signs evident on clinical neurological examination. [ncbi.nlm.nih.gov]
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 [orthobullets.com]
- Spastic Paraplegia
metastatic tumors), subacute combined degeneration of the spinal cord (vitamin B 12 deficiency), hereditary spastic paraplegia, normal pressure hydrocephalus and spinal cord infarction ( Table 4 ). 10 Most of these conditions can easily be distinguished [aafp.org]
Other conditions like primary spinal cord tumors, syringomyelia, metastatic tumors, subacute combined degeneration of the spinal cord (vitamin B12 deficiency), hereditary spastic paraplegia, normal pressure hydrocephalus, and spinal cord infarction can [boneandspine.com]
- Decreased Proprioception
Table 1 – Signs/symptoms of cord compression New or worsening back pain Weakness Loss of sensation in affected limbs Decreased proprioception Numbness / tingling / coldness Urinary retention / constipation Ataxia / spasticity Bowel / bladder incontinence [oncolink.org]
- Dropping Things
Symptoms that may be associated with cervical myelopathy include: Neck pain and stiffness Tingling Numbness Weakness Find yourself dropping things Hand clumsiness (eg, buttoning a shirt) Balance problems Difficulty walking Possible Causes There are many [spineuniverse.com]
In order to make the diagnosis of cervical cord compression and establish the underlying cause, a comprehensive clinical approach is necessary. A properly conducted neurological examination is the crucial step for raising suspicion toward this entity    . Several findings indicative of an ongoing pathological process involving the cervical spinal cord are    :
- Hyperreflexia - A brisk triceps reflex accompanied by the absence of biceps and supinator reflexes are considered to be pathognomonic findings of cervical spondylotic myelopathy associated with cervical spondylosis at the C5-C6 interspace .
- Limited neck motion and pain - Extension of the neck is almost universally limited . Lhermitte's sign, a generalized shock-like sensation produced after neck flexion, is another important sign of cervical cord compression .
- Gait changes - A positive Romberg test (the patient loses balance while standing with closed eyes and arms being stretched anteriorly) and abnormal findings during walking tests (heel-to-toe tandem walking, heel-walking, and toe-walking) are frequently observed  .
As soon as a presumptive diagnosis is made, imaging studies must be employed. Plain radiography of the cervical spine is of limited use, which is why magnetic resonance imaging (MRI) and computed tomography (CT) are recommended    . These procedures can identify intrinsic spinal cord changes, tumors, herniated discs, skeletal abnormalities (CT is favored over MRI in this case), and determine the exact cause of the compression    .
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- Chan CK, Lee HY, Choi WC, Cho JY, Lee SH. Cervical cord compression presenting with sciatica-like leg pain. Eur Spine J. 2011;20(Suppl 2):217-221.
- Meyer F, Börm W, Thomé C. Degenerative Cervical Spinal Stenosis: Current Strategies in Diagnosis and Treatment. Dtsch Arztebl Int. 2008;105(20):366-372.
- Lebl DR, Hughes A, Cammisa FP, O’Leary PF. Cervical Spondylotic Myelopathy: Pathophysiology, Clinical Presentation, and Treatment. HSS J. 2011;7(2):170-178.
- Todd AG. Cervical spine: degenerative conditions. Curr Rev Musculoskelet Med. 2011;4(4):168-174.
- Yeung JT, Johnson JI, Karim AS. Cervical disc herniation presenting with neck pain and contralateral symptoms: a case report. J Med Case Rep. 2012;6:166.