Article Figures & Data
Figures
- Figure 1.
Select physical examination maneuvers to support a diagnosis of cervical spondylotic myelopathy. (A) Finger escape sign; (B) grip and release test; (C) hyperactive pectoralis reflex; (D) inverted radial reflex; (E) Hoffman sign.
- Figure 2.
Lateral cervical spine radiograph demonstrating Torg-Pavlov ratio at C5. Calculated by dividing canal diameter (A) by vertebral body diameter (B). Ratio <0.8 signifies canal stenosis. Canal diameter <12 mm is correlated with cord compression.
- Figure 3.
Algorithm to aid in the diagnosis, work-up, management, and appropriate referral of a patient with suspected cervical spondylotic myelopathy. Abbreviations: CSM, Client Services Manager; CT, computed tomography; MRI, Magnetic Resonance Imaging; JOA, Japanese Orthopaedic Association.
Tables
Grade Description 0 Signs and symptoms of root involvement without spinal cord disease 1 Signs of spinal cord disease without difficulty in walking 2 Slight difficulty in walking that does not prevent full-time employment 3 Difficulty in walking that prevents full-time employment or daily takes without requiring assistance with walking 4 Ability to walk only with assistance 5 Chair bound or bedridden - Table 2.
Symptoms and Physical Exam Findings Commonly Seen in Patients with Cervical Spondylotic Myelopathy
Upper Extremity Findings Lower Extremity Findings Additional Findings *Decreased hand dexterity *Impairment of gait and/or falls Lhermitte’s phenomenon Lower motor neuron signs (muscle weakness, atrophy, fasciculation, hyporeflexia, hypotonia) Upper motor neuron signs (weakness, hyperreflexia, hypertonia) Incontinence Change in pain, temperature, proprioception, dermatomal sensation Change in pain, temperature, proprioception, dermatomal sensation Neck pain Motor deficits Motor deficits Thenar atrophy Babinski reflex Hoffman sign Romberg test Inverted radial reflex Sustained foot clonus Finger escape sign Grip and release test Hyperactive pectoralis reflex ↵* Most frequently found upon initial presentation.
- Table 3.
Japanese Orthopaedic Association Scale for Cervical Myelopathy Evaluation (0 to 17 Points)
Evaluation Description Point Motor function of upper limbs Unable to eat with cutlery or to button shirt 0 Unable to eat with a spoon, but able to move hands 1 Able to button shirt with great difficulty 2 Able to button shirt with slight difficulty 3 No dysfunction 4 Motor dysfunction score of the lower extremity Complete loss of motor and sensory function 0 Sensory preservation without ability to move legs 1 Able to move legs, but unable to walk 2 Able to walk on flat floor with a walking aid 3 Able to walk up and/or down stairs with hand rail 4 Moderate-to-significant lack of stability, but able to walk up and/or down without hand rail 5 Mild lack of stability but walks with smooth reciprocation unaided 6 No dysfunction 7 Sensory dysfunction score of the upper extremities Complete loss of motor and sensory function 0 Severe sensory loss of pain 1 Mild sensory loss 2 No sensory loss 3 Sphincter dysfunction score Unable to micturate voluntarily 0 Marked difficulty with micturition 1 Mild to moderate difficulty with micturition 2 Normal micturition 3 - Table 4.
Imaging Modalities Used in the Workup of Cervical Spondylotic Myelopathy with Their Respective Utility and Associated Cost
Imaging Modality Utility †Cost *Magnetic resonance imaging Visualize intervertebral discs, ligaments, and surrounding soft tissues; obtain transverse area of spinal cord; determine severity of cord compression and degeneration; diagnose CCSS Mean operating expense: $165
Mean charge per procedure: $2048Radiographs Determine lordosis/kyphosis; calculate Torg-Pavlov ratio; evaluate spinal column alignment, ROM, and flexion/extension Mean operating expense: $55
Mean charge per procedure: $410Computed tomography (± myelography) Diagnose OPLL; assess transverse foramen for vertebral artery compression; evaluate cervical cord compression; obtain transverse area of spinal cord; perform CT-myelogram in patients with contraindication to MRI Mean operating expense: $51
Mean charge per procedure: $1565Electrophysiology Assess peripheral neurologic functionality; rule out other neurologic diseases Mean operating expense: varies
Mean charge per procedure: varies - Table 5.
AOSpine North America and Cervical Spine Research Society Guidelines for Management of Cervical Spondylotic Myelopathy Based on Japanese Orthopaedic Association Severity
Classification JOA Score Recommendation Strength of Recommendation Quality of Evidence Mild CSM 15 to 17 Offer surgery or trial of structured rehabilitation Weak Very low to low Moderate CSM 12 to 14 Surgical intervention Strong Moderate Severe CSM 0 to 11 Surgical intervention Strong Moderate CSM, cervical spondylotic myelopathy; JOA, Japanese Orthopaedic Association.
