Degenerative Cervical Myelopathy: Clinical Presentation, Assessment, and Natural History
Abstract
:1. Introduction
2. Topics
2.1. Pathophysiology
2.2. Presentation
2.3. Differential Diagnoses
2.4. Diagnosis
2.5. Natural History and Conservative Management
2.6. Surgical Management
3. Conclusions
Author Contributions
Funding
Data Availability Statement
Conflicts of Interest
References
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Category | Score | Description |
---|---|---|
Upper Extremity Motor | 0 | Unable to move hands |
1 | Unable to eat with spoon but able to move hands | |
2 | Unable to button shirt but able to eat with spoon | |
3 | Able to button shirt with great difficulty | |
4 | Able to button shirt with mild difficulty OR other mild fine motor dysfunction (marked change in handwriting, frequent dropping of objects, difficulty clasping jewelry, etc.) | |
5 | Normal hand coordination | |
Lower Extremity Motor/Sensation | 0 | Complete loss of movement and sensation |
1 | Complete loss of movement, some sensation present | |
2 | Unable to walk but some movement | |
3 | Able to walk on flat ground with walking aid | |
4 | Able to walk without walking aid, must hold handrail on stairs | |
5 | Moderate to severe gait imbalance but able to take stairs without handrail | |
6 | Mild imbalance standing OR walking | |
7 | Normal walking | |
Upper Extremity Sensory | 0 | Complete loss of hand sensation |
1 | Severe loss of hand sensation OR pain | |
2 | Mild loss of hand sensation | |
3 | Normal hand sensation | |
Urinary function | 0 | Inability to voluntarily urinate (requiring catheterization) |
1 | Frequent urinary incontinence (more than once monthly) | |
2 | Urinary urgency OR occasional stress incontinence (less than once monthly) | |
3 | Normal urinary function |
Differential Diagnosis | Differentiating Findings |
---|---|
Amyotrophic lateral sclerosis [7,33] | Presence of cranial nerve findings (e.g., dysphagia, dysarthria) Absence of sensory findings |
Brain neoplasm | Presence of cranial nerve findings Lateralizing findings (e.g., unilateral weakness/sensory changes) Headache Vomiting Altered level of consciousness |
Multiple sclerosis [7,33] | Visual changes Cranial nerve findings Fatigue |
Peripheral nerve entrapment (e.g., carpal tunnel syndrome, ulnar neuropathy) [33] | Absence of upper motor neuron findings |
Normal pressure hydrocephalus | Cognitive disturbances Speech or swallowing difficulty |
Vitamin B deficiency [7,33] | Fatigue Cognitive disturbances Glossitis Visual changes |
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Lannon, M.; Kachur, E. Degenerative Cervical Myelopathy: Clinical Presentation, Assessment, and Natural History. J. Clin. Med. 2021, 10, 3626. https://doi.org/10.3390/jcm10163626
Lannon M, Kachur E. Degenerative Cervical Myelopathy: Clinical Presentation, Assessment, and Natural History. Journal of Clinical Medicine. 2021; 10(16):3626. https://doi.org/10.3390/jcm10163626
Chicago/Turabian StyleLannon, Melissa, and Edward Kachur. 2021. "Degenerative Cervical Myelopathy: Clinical Presentation, Assessment, and Natural History" Journal of Clinical Medicine 10, no. 16: 3626. https://doi.org/10.3390/jcm10163626