4.6.16 – VA ambulatory report – cervical spondylotic myelopathy

Cervical Spondylotic Myelopathy

  • Most common cause of spinal dysfunction in geriatric populations.
  • Myelopathy occurs as a result of both mechanical factors (e.g., degenerative disc disease, subluxation) and spinal cord ischemia. The spinal cord ischemia most likely occurs at the level of the impaired microcirculation and can occur from both reduced flow as well as compression of the larger vessels (e.g., anterior spinal artery).
  • Hallmark symptoms of cervical spondylotic myelopathy are gait abnormalities and weakness or stiffness of the legs. It is usually an insidious process. In the early stages, patients complain of subtle changes in gait or balance.
  • Physical exam findings are often suggestive of UMN dysfunction (hyperactive DTRs, ankle/patellar clonus, spasticity LE > UE, and Babinski’s sign). Lower extremity motor examination most frequently reveals weakness in the iliopsoas > quadriceps. The gait is usually a stiff or spastic gait.
  • See the differential diagnosis for cervical spondylotic myelopathy below taken from the article below.

DDx for Cervical Spondylotic MyelopathyBaron, Eli M., and William F. Young. “Cervical Spondylotic Myelopathy: A Brief Review of Its Pathophysiology, Clinical Course, and Diagnosis.” Neurosurgery 60.SUPPLEMENT (2007): S35-41. Attached Here

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