Cervical stenosis with myelopathy can have symptoms similar to several other conditions, such as multiple sclerosis (MS) or vitamin B12 deficiency, among others. 1 M Hochman, S Tuli. Cervical Spondylotic Myelopathy: A Review. The Internet Journal of Neurology. 2004. 4(1). ispub.com It is important to get an accurate diagnosis before starting treatment.
Diagnosing cervical stenosis with myelopathy usually begins with a detailed medical history of the patient and a physical exam in the doctor's office. If cervical myelopathy is suspected, an MRI will likely be requested to confirm the diagnosis.
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Clinical Signs of Cervical Stenosis with Myelopathy
Symptomatic cervical myelopathy leads to several functions of the nerves in the spinal cord not working properly, called “deficits.” These nerve deficits can be picked up from clinical signs during the physical exam.
For example, one or more of the following signs could be present:
- Increased muscle tone in the legs
- Accentuated deep tendon reflexes in the knee and ankle (hyperreflexia)
- Forced ankle extension causes foot to involuntarily move up and down (clonus)
- Scratching foot’s sole causes big toe to go up (Babinski reflex) instead of down (normal reflex)
- Flicking middle finger causes thumb and index finger to flex (Hoffman reflex)
- Difficulty walking and placing one foot in front of the other (tandem walking)
This is not a complete list of clinical signs for long-tract deficits associated with cervical myelopathy. Furthermore, some clinical signs can be present for different conditions, so a diagnosis should not be made based solely on a few clinical signs.
Cervical stenosis with myelopathy can usually be diagnosed with a patient history and medical exam. In some cases, especially if surgery will be considered, the doctor will probably also request advanced diagnostics, which could include an:
- Imaging study. If cervical stenosis with myelopathy is suspected based on medical history and physical exam, the spinal cord impingement within the narrowed canal can usually be confirmed with an MRI scan or CT scan with myelogram. Flexion/extension lateral cervical spine x-rays are also useful to check for abnormal motion and instability, which can also be present with cervical myelopathy and would affect treatment decisions.
- Electrical study. In some cases, a somatosensory evoked potential (SSEP) test is done by stimulating the arms/legs and then reading the signal in the brain. A delay in the length of time it takes the signal to reach the brain indicates a compromise of the spinal cord.
Getting a diagnosis for cervical stenosis with myelopathy relatively early in the process can lead to better results in treatment because less damage has been done to the spinal cord.
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