Neck (Cervical)
Cervical Myelopathy
경추 척수증
A serious condition with limb dysfunction due to spinal cord compression
- How common
- Relatively common in the elderly
- Typical age
- 50s and older
What is it?
Osteophytes, hypertrophied ligaments, or disc material compress the spinal cord itself, producing upper motor neuron signs.
Commonly affected: Cord compression at C3-4, C4-5, and C5-6 levels is most common
How it develops
- Spinal canal narrowingDegenerative changes narrow the spinal canal, directly compressing the cord.
- Spinal cord ischemiaCompression reduces blood flow to the spinal cord.
- Spinal cord injurySustained compression causes intramedullary cell damage and demyelination.
- Upper motor neuron syndromeWeakness, spasticity, hyperreflexia, and pathologic reflexes appear.
Symptoms
- Gait disturbanceUnsteady 'drunken' gait, difficulty descending stairs
- Impaired hand functionDifficulty with fine motor tasks such as buttoning, using chopsticks, and writing
- Limb spasticityStiffness in the arms and legs
- Bladder dysfunctionUrinary frequency and incontinence may develop
- Lhermitte signElectric-shock sensation radiating down the back or limbs with neck flexion
How it is examined
- HyperreflexiaBrisk patellar and Achilles tendon reflexes
- Hoffman sign (+)Flicking the middle finger causes thumb flexion → sign of upper motor neuron lesion
- Babinski sign (+)Stroking the sole causes upgoing great toe
- Gait examinationDifficulty with tandem gait
Imaging
X-ray identifies causes of cervical stenosis.
- Multilevel osteophyte formation
- Disc space narrowing
- Decreased cervical canal diameter
MRI is essential. It demonstrates cord compression and intramedullary signal change.
- Direct spinal cord compression
- T2 intramedullary hyperintensity (marker of cord injury)
- Multilevel stenosis
Non-surgical care
- Observation (mild cases)Close observation when symptoms are very mild
- Cervical braceCervical orthosis to limit excessive motion
Conservative options are generally tried first. Medications listed here can have side effects — discuss them with your prescriber.
When surgery is considered
Surgical treatment is usually required — neurological damage is difficult to reverse
Procedures that may be discussed
- Anterior cervical decompression and fusion (ACDF)
- Posterior laminoplasty
- Posterior cervical decompression and fusion
Outlook
Early surgery can improve symptoms. Recovery becomes harder the longer surgery is delayed. Immediate specialist consultation is essential.