From the Guidelines
Myelopathic symptoms are defined as signs of spinal cord dysfunction that occur when the spinal cord is compressed or damaged, and can include weakness, numbness, difficulty with fine motor skills, unsteady gait, and abnormal reflexes, among others. These symptoms typically develop gradually and may worsen over time if the underlying cause is not addressed 1. The specific symptoms depend on the location and severity of spinal cord compression, with cervical (neck) myelopathy affecting the arms and legs, while thoracic myelopathy primarily affects the lower body 1. Myelopathic symptoms can be caused by primary intrinsic disorders of the spinal cord, such as neoplastic, infectious, inflammatory, neurodegenerative, vascular, nutritional, and idiopathic conditions, or by secondary conditions that result in extrinsic compression of the spinal cord 1.
Some common myelopathic symptoms include:
- Weakness or numbness in the arms or legs
- Difficulty with fine motor skills like buttoning clothes or writing
- Unsteady gait or balance problems
- Abnormal reflexes
- Bowel or bladder dysfunction, such as incontinence or retention
- Pain, including electric shock-like sensations that travel down the spine when bending the neck (Lhermitte's sign) 1.
It is essential to recognize these symptoms early, as prompt treatment can prevent permanent neurological damage. Imaging plays a crucial role in the evaluation of myelopathy, with MRI being the preferred modality due to its superb contrast resolution of the spinal cord 1.
From the Research
Myelopathic Symptoms
Myelopathic symptoms are a complex set of symptoms that occur due to pathology affecting the spinal cord. The symptoms can vary depending on the location and extent of the spinal cord damage.
- Symptoms of myelopathy may include:
- Pain, most commonly over the site of the lesion 2
- Motor abnormalities such as sudden weakness and paralysis, clumsiness, and fatigability 2
- Sensory complaints like paresthesias, numbness, deadness, dysesthesias, and bladder symptoms 2
- Hand clumsiness, wide-based gait, and paresis in cases of cervical myelopathy 3
- Progressive numbness, weakness, and severe spasms in both lower extremities, and bowel and bladder incontinence in some cases 3
Clinical Diagnosis
The clinical diagnosis of myelopathy requires a detailed history and physical examination to define the clinical syndrome 4. Neurological examination excludes cerebral disease, and motor and sensory examination may define the level of the lesion 2.
- A comprehensive clinical neurological examination is essential in the setting of lower extremity symptoms with progressive bilateral leg weakness and urinary incontinence to consider cervical spine workup in addition to thoracic and lumbar spine 3
- Laboratories and imaging, particularly with magnetic resonance imaging, can suggest a cause of myelopathy 5