Degenerative Cervical Myelopathy: A Practical Approach to Diagnosis

Abstract

Study design: Narrative Review.

Objectives: The objective of this review is to provide a stepwise approach to the assessment of patients with potential symptoms of degenerative cervical myelopathy (DCM).

Methods: N/A.

Results: DCM is an overarching term used to describe progressive compression of the cervical spinal cord by age-related changes to the spinal axis. These alterations to normal anatomy narrow the spinal canal, reduce the space available for the spinal cord, and may ultimately compress the ascending and descending neural tracts. Patients with DCM present with a wide range of symptoms that can significantly impact quality of life, including bilateral hand numbness and paresthesia, gait impairment, motor weakness of the upper and lower extremities, and bladder and bowel dysfunction. Unfortunately, DCM is often misdiagnosed, resulting in delayed assessment and management by the appropriate specialist. The proper evaluation of a patient with suspected DCM includes obtaining a detailed patient history, conducting a comprehensive neurological examination, and ordering appropriate tests to rule in or out other diagnoses.

Conclusion: This review summarizes a stepwise approach to the diagnosis of patients with DCM.

Keywords: cervical spondylotic myelopathy; degenerative cervical myelopathy; diagnosis; ossification of the posterior longitudinal ligament.

Figure 1.

An approach to the diagnosis of degenerative cervical myelopathy. EMG, electromyography; NCS, nerve conduction studies; SLE, systemic lupus erythematosus; AIDP, acute inflammatory demyelinating polyneuropathy; CIDP, chronic inflammatory demyelinating polyneuropathy; IBM, influsion body myositis; SPEP, serum protein electrophoresis; HIV, human immunodeficiency virus; RPR, rapid plasma reagin; ANCA, antineutrophil cyoplasmic antibody; C3/C4, complement 3/4; RF, rheumatoid arthritis; ESR, erythrocyte sedimentation rate; CRP, C-reactive protein; ACE, angiotensin-converting enzyme; Cu, copper; Zn, sinc; TSH, thyroid stimulating hormone; fT4, free T4; CT, computed tomography; CK, creatinine kinase; LDH, lactate dehydrogenase; LFTs, liver function tests; PTH, parathyroid hormone.

Figure 2.

The role of various imaging modalities in the diagnosis and management of degenerative cervical myelopathy. (i) Lateral radiograph for the assessment of cervical alignment; (ii) flexion-extension radiographs for evaluation of spondylolisthesis and cervical instability; (iii) post-operative radiographs for assessment of fusion status and the position of instrumentation; (iv) computed tomography scans for the detection of bony abnormalities and ossification of the posterior longitudinal ligament; and (v) magnetic resonance imaging for the evaluation of the extent of spinal canal stenosis, degree of cord compression, and presence of intramedullary signal change.