From the Guidelines
Myelopathy presents with several characteristic clinical signs that indicate spinal cord compression or damage, including weakness and spasticity in the limbs, hyperreflexia with positive Babinski sign, sensory deficits, and gait abnormalities, as noted in the 2021 update of the ACR Appropriateness Criteria for myelopathy 1. The clinical signs of myelopathy can vary depending on the level and extent of spinal cord involvement.
- Cervical myelopathy can affect both upper and lower extremities, while thoracic myelopathy typically affects only the lower limbs.
- Patients may experience the "myelopathy hand," characterized by loss of fine motor control and dexterity in the hands.
- Bowel and bladder dysfunction may occur, manifesting as urinary urgency, frequency, or retention.
- Lhermitte's sign, which is an electric-like sensation down the spine with neck flexion, is frequently present. These signs result from interruption of the corticospinal tracts, posterior columns, and other spinal cord pathways due to compression or damage to the spinal cord, as discussed in the context of acute and chronic myelopathy 1. Early recognition of these signs is crucial, as prompt treatment can prevent permanent neurological damage, highlighting the importance of timely diagnosis and intervention in the management of myelopathy 1.
From the Research
Clinical Signs of Myelopathy
The clinical signs of myelopathy can vary depending on the underlying cause, but common symptoms include:
- Motor abnormalities such as sudden weakness and paralysis, clumsiness, and fatigability 2
- Sensory complaints like paresthesias, numbness, deadness, dysesthesias, and bladder symptoms 2
- Pain, most commonly over the site of the lesion 2
- Gait and sensory disturbances 3
Diagnostic Approach
The diagnosis of myelopathy is based on a combination of clinical findings, laboratory tests, and imaging studies. The clinical approach to myelopathy diagnosis involves:
- A detailed history and physical examination to define the clinical syndrome 4
- Neuroimaging, such as magnetic resonance imaging (MRI), to suggest a cause and identify the level of the lesion 4, 5
- Laboratory tests, such as enzyme-linked immunosorbent assay (ELISA), to measure the levels of certain biomarkers 6
Common Causes of Myelopathy
The most common causes of myelopathy include:
- Compressive myelopathy from degenerative disease of the vertebral column 4, 5
- Infectious, immune-mediated, nutritional, vascular, and neoplastic etiologies 3, 5
- Spinal cord compression due to extradural masses caused by metastatic disease to bone or blunt trauma 4
Importance of Imaging
Imaging studies, particularly MRI, play a crucial role in the diagnosis of myelopathy. They help to: