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Cervical Cord Compression

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.


Presentation

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 [1] [2] [3]. 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) [1] [3] [4]. It is not uncommon for patients to neglect early symptoms [4], 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 [1] [3] [4]. Paresthesias and weakness eventually arise. A more severe form of cervical cord compression leads to inadequate sphincter control and paralysis [3] [4]. 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 [2].

Yawning
  • A 40-year-old man presented with severe pain radiating to both legs when he yawned, sneezed, or extended his jaw (a protruded-head position).[ncbi.nlm.nih.gov]
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]
  • 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]
  • walking placing one foot in front of the other (tandem walking).[necksolutions.com]
  • Symptoms CSM can cause a variety of symptoms, including: a tingling, prickling or "pins and needles" sensation (paresthesia); numbness; weakness, difficulty lifting objects, or frequent dropping of objects; difficulty walking (loss of balance), wide-based[shorelineortho.com]
  • Symptoms include: Pain or stiffness Burning sensation Sciatic pain Weakness or numbness in limbs, arms, and feet Trouble controlling bladder Difficulty walking or moving normally If you are experiencing pain in your neck or back, have a condition that[intermountainhealthcare.org]
Neck Pain
  • 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.[ncbi.nlm.nih.gov]
  • 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]
  • Neck pain due to cervical spine and related disorders is a common and often debilitating problem and an important reason for seeking medical attention. Neck pain more often arises without relation to a specific activity or neck trauma.[necksolutions.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]
Hyperreflexia
  • 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]
  • 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]
  • 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]
  • […] retardation) – 1 Serious urination difficulty (residual urine, dysuria) – 0 Urine retention Additional findings associated with myelopathy: Muscular tone in the legs will be increased, Deep tendon reflexes in the knee and ankle will be accentuated (hyperreflexia[necksolutions.com]
  • A characteristic physical finding of CSM is hyperreflexia. The biceps and supinator reflexes (C5 and C6) may be absent, with a brisk triceps reflex (C7).[aafp.org]
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[boneandspine.com]
Long Tract Signs
  • 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]
Neglect
  • It is not uncommon for patients to neglect early symptoms, but as the severity of compression increases more pronounced manifestations develop.[symptoma.com]
  • . , van Belkum A. 2004 Mycetoma caused by Madurella mycetomatis : a neglected infectious burden Lancet Infect Dis 4 566 574 [CrossRef] [PubMed] [Google Scholar] Cascio A. , Mandraffino G. , Cinquegrani M. , Delfino D. , Mandraffino R. , Romeo O. , Criseo[jmmcr.microbiologyresearch.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]
Urinary Incontinence
  • When urinary incontinence starts or when patients become dependent on a wheel chair for long period of time, the chance that surgery will help decreases.[spinedoctormiami.com]

Workup

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 [1] [3] [4] [5]. Several findings indicative of an ongoing pathological process involving the cervical spinal cord are [1] [3] [4] [5]:

  • 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 [1].
  • Limited neck motion and pain - Extension of the neck is almost universally limited [4]. Lhermitte's sign, a generalized shock-like sensation produced after neck flexion, is another important sign of cervical cord compression [1].
  • 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 [1] [3].

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 [1] [3] [4] [5]. 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 [1] [3] [4] [6].

Treatment

  • The clinical presentation, radiologic features, and the operative treatment are summarized. The mechanism by which this lesion caused a severe cervical pain is discussed.[ncbi.nlm.nih.gov]
  • Neurological function improved rapidly after treatment with intravenous pulse corticosteroids given before surgical fusion of the cervical spine. Post operative MRI showed a significant reduction in size of the pannus.[ncbi.nlm.nih.gov]
  • The patient regained strength in all extremities in the postoperative period and required rehabilitation treatment. Spinal gout should be considered in all patients presenting myelopathy and history of gout.[ncbi.nlm.nih.gov]
  • , and arm pain after the fourth manipulative treatment.[chiro.org]
  • Nonsurgical Treatment In milder cases, initial treatment for CSM may be nonsurgical. The goal of nonsurgical treatment is to decrease pain and improve the patient's ability to perform daily activities.[orthoinfo.aaos.org]

Prognosis

  • Prognosis Prognosis is variable depending on the age of onset, rate of disease progression, age at initiation of ERT and on the quality of the medical care provided.[orpha.net]
  • Prognosis The spinal cord has very limited powers of regeneration. Prognosis for neurological deficit depends on the magnitude of the spinal cord damage present at the onset.[patient.info]
  • Usually, the lesion is amenable to total surgical extirpation and the functional prognosis is good.[revistaneurocirugia.com]
  • Treatment and prognosis [ edit ] Dexamethasone (a potent glucocorticoid ) in doses of 16 mg/day may reduce edema around the lesion and protect the cord from injury. It may be given orally or intravenously for this indication.[en.wikipedia.org]
  • In patients who have had symptoms for a slightly longer period of time, the prognosis is less clear.[spine.org]

Etiology

  • The etiology of upper cervical cord compression and radiological features of cervical OPLL was determined.[ncbi.nlm.nih.gov]
  • Imaging studies, magnetic resonance imaging (MRI) and computed tomography (CT), are frequently necessary to identify the underlying etiology.[symptoma.com]
  • Routine studies in working up cervical vertigo ENG Audiogram VEMP OAE MRI-neck (see above) and MRI-brain Flexion/extension x-rays of neck CT-angiography (if MRI-neck is negative or there is strong suspicion of vascular etiology, given that renal function[dizziness-and-balance.com]
  • An evaluation for demyelinating, infectious, inflammatory, and neoplastic etiologies was unrevealing. A course of high-dose steroids provided only minimal clinical improvement.[neurology.org]
  • A more slowly progressing form has been described as having later onset, mildly elevated glycosaminoglycans (generally Etiology The disorder is transmitted in an autosomal recessive manner and is caused by mutations in the ARSB gene, located in chromosome[orpha.net]

Epidemiology

  • Reference article This is a summary article ; read more in our article on spinal cord compression . anatomy spinal cord cauda equina epidemiology number of different causes different patient groups for each pathology may affect all age groups presentation[radiopaedia.org]
  • Summary Epidemiology Birth prevalence is between 1 in 43,261 and 1 in 1,505,160 live births. Clinical description The disorder shows a wide spectrum of symptoms from slowly to rapidly progressing forms.[orpha.net]
  • Gregory DCc aRhode Island Spine Center, Pawtucket, RI; and Department of Community Health, Brown University Medical School, Providence, RI bDepartment of Public Health Sciences and Epidemiology, John A.[sogacot.org]
  • Epidemiology Cervical spondylotic myelopathy is the most common disorder of the spinal cord in persons older than 55 years of age. [5] [8] [9] Radiologic spondylotic changes increase with patient age - 90% of asymptomatic persons older than 70 years have[physio-pedia.com]
  • Fibromyalgia criteria and severity scales for clinical and epidemiological studies: a modification of the ACR Preliminary Diagnostic Criteria for Fibromyalgia. J Rheumatol . 2011 Jun;38(6):1113–22. PubMed #21285161.[painscience.com]
Sex distribution
Age distribution

Pathophysiology

  • The pathophysiologic basis of such an abnormality was presumed to be myelomalacia or cord gliosis secondary to a long-standing compressive effect of the spinal cord.[ncbi.nlm.nih.gov]
  • He is well known for his work on the classification of myoclonus and his studies on the physiology and pathophysiology of voluntary movement including dystonia.[books.google.com]
  • […] case 1) thoracic or radicular pain constant, progressive, non-mechanical pain systemically unwell widespread neurological signs and symptoms power reduction: 80% of patients need help to mobilise loss of sensation: saddle anaesthesia urinary retention pathophysiology[radiopaedia.org]
  • Pathophysiology of Cervical Spondylotic Myelopathy There are three important pathophysiologic factors in the development of cervical spondylotic myelopathy Static mechanical Osteophytic overgrowth of cervical spondylosis ventrally and buckling of ligamentum[boneandspine.com]
  • Neurological manifestation of cervical spondylosis: An overview of signs, symptoms, and pathophysiology. Neurosurgery 2007;60(1, Supp 1 1): S14-20). Matz PG, Pritchard PR, Hadley MN.[americannursetoday.com]

Prevention

  • This is the first report of laminoplasty as a useful surgical approach for intraspinal exostosis to prevent postoperative cervical instability.[ncbi.nlm.nih.gov]
  • One must realize that the degenerative process can be managed, but it cannot be prevented by diet, exercise, or lifestyle changes.[gulfcoastspinecare.com]
  • The goals of spine surgery to treat myelopathy are: (1) remove pressure from the spinal cord, (2) prevent symptoms from becoming worse, and (3) improve your condition.[spineuniverse.com]
  • Regular use of safety belts can help prevent or minimize neck injury in automobile accidents. The most common neck injuries involve the soft tissues: the muscles and ligaments.[shorelineortho.com]
  • Rapid diagnosis and management are essential to have the highest chances of preventing permanent loss of function.[patient.info]

References

Article

  1. Young WF. Cervical spondylotic myelopathy: a common cause of spinal cord dysfunction in older persons. Am Fam Physician. 2000;62(5):1064-1070, 1073.
  2. 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.
  3. Meyer F, Börm W, Thomé C. Degenerative Cervical Spinal Stenosis: Current Strategies in Diagnosis and Treatment. Dtsch Arztebl Int. 2008;105(20):366-372.
  4. Lebl DR, Hughes A, Cammisa FP, O’Leary PF. Cervical Spondylotic Myelopathy: Pathophysiology, Clinical Presentation, and Treatment. HSS J. 2011;7(2):170-178.
  5. Todd AG. Cervical spine: degenerative conditions. Curr Rev Musculoskelet Med. 2011;4(4):168-174.
  6. 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.

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Last updated: 2018-06-21 21:30