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    .
Cervical Cord Compression Treatment Conservative treatment like NSAIDS, activity modification and exercises may help relieve the arm pain. [emoryhealthcare.org]
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]
The goal of nonsurgical treatment is to decrease your pain and improve your ability to perform daily activities. [directorthocare.com]
High signal intensity of the spinal cord produced by compressive lesions appears to be an important indicator for predicting prognosis. Article History Published in print: 1989 [pubs.rsna.org]
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]
Usually, the lesion is amenable to total surgical extirpation and the functional prognosis is good. [revistaneurocirugia.com]
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]
*Reflexes tend to be absent at the level of the lesion, as the lower motor neurone within the ventral horn is compressed, so producing a lower motor neurone deficit Any autonomic involvement is a late stage and therefore carries a worse prognosis. [teachmesurgery.com]
The etiology of upper cervical cord compression and radiological features of cervical OPLL was determined. [ncbi.nlm.nih.gov]
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]
Imaging studies, magnetic resonance imaging (MRI) and computed tomography (CT), are frequently necessary to identify the underlying etiology. [symptoma.com]
Pathology Etiology There are numerous causes of cord compression. [radiopaedia.org]
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]
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]
The inclusion of volunteers from the epidemiological study, complying with the criteria for the current study into prospective evaluation, had been planned beforehand. [onlinelibrary.wiley.com]
"Epidemiology of cervical spondylotic myelopathy and its risk of causing spinal cord injury: a national cohort study". Neurosurgical Focus. 35 (1): E10. doi:10.3171/2013.4.FOCUS13122. PMID 23815246. Shedid, Daniel; Benzel, Edward C. (2007). [en.wikipedia.org]
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]
A team of internationally renowned authorities offer cutting-edge, in-depth guidance on the use of TMS to study brain physiology and pathophysiology as well as its current and future therapeutic uses. [books.google.com]
The pathophysiologic basis of this high signal intensity area was oresumed to be edema or gliosis or myelomalacia secondary to a choronic compressive effect of the cervical spinal cord. [petit.lib.yamaguchi-u.ac.jp]
[…] 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 mobilize loss of sensation: saddle anesthesia urinary retention pathophysiology [radiopaedia.org]
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]
Focused history and recognition of abnormal neurological signs by focused physical examination is crucial to preventing devastating morbidity. [bjgp.org]
Treatment of myelopathy is aimed at preventing the symptoms from getting worse and involves a surgical procedure. Often times, a disability that develops may not get better even with a surgery to take pressure off the spine. [beaconortho.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]
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