What are the signs of myelopathy?

Signs of Myelopathy

The key signs of myelopathy include motor system abnormalities such as hypertonia, hyper-reflexia, positive Babinski sign, sensory deficits, and gait disturbances, which indicate spinal cord compression or dysfunction. 1

Clinical Manifestations

Motor Signs

• Hypertonia and hyper-reflexia 1
• Positive Babinski sign (upgoing plantar reflex) 1
• Weakness in limbs (may be asymmetric) 1
• Spasticity 1
• Decreased fine motor control and hand clumsiness 2
• In severe cases, paraplegia with progressive spasticity 1

Sensory Signs

• Sensory loss below the level of the lesion 1
• Paresthesia (numbness, tingling) 2
• Decreased pin and vibration sensibility 1
• Loss of proprioception leading to unsteady gait 1

Gait Abnormalities

• Wide-based, unsteady gait 2
• Difficulty with balance and coordination 1
• Spastic gait pattern 1

Autonomic Dysfunction

• Sphincter dysfunction (urinary urgency, frequency, or retention) 1
• Bowel dysfunction (constipation or incontinence) 2
• Sexual dysfunction 3

Diagnostic Evaluation

Physical Examination Findings

• Hoffman's sign (flicking the distal phalanx of the middle finger causes flexion of the terminal phalanx of the thumb and index finger) 3
• Inverted radial reflex (tapping the brachioradialis tendon causes finger flexion instead of supination) 3
• Lhermitte's sign (electric-like sensation down the spine with neck flexion) 3
• Romberg's test may be positive (inability to maintain balance with eyes closed) 3

Imaging

• MRI of the spine is the gold standard for evaluation 1, 3
• MRI can identify the cause of myelopathy (compression, inflammation, etc.) 4
• CT myelography may be useful when MRI is contraindicated 1

Common Etiologies

Degenerative

• Cervical spondylotic myelopathy (most common cause) 5
• Disc herniation 1
• Ligamentum flavum ossification 1

Non-Degenerative

• Inflammatory/demyelinating (multiple sclerosis, neuromyelitis optica) 3
• Infectious (viral, bacterial, parasitic) 3
• Vascular (spinal cord infarction, arteriovenous malformation) 3
• Neoplastic (primary or metastatic tumors) 5
• Metabolic (vitamin B12 deficiency) 3
• Traumatic 5

Special Considerations

Hepatic Myelopathy

• Characterized by severe motor abnormalities exceeding mental dysfunction 1
• Associated with long-standing portocaval shunting 1
• Presents with progressive spasticity and weakness of lower limbs with hyper-reflexia 1
• May be unresponsive to ammonia-lowering therapy but can reverse with liver transplantation 1

Progression Patterns

• Myelopathy can present acutely, subacutely, or chronically 6
• Acute myelopathy: symptoms progress to maximum deficit within 21 days 6
• Chronic myelopathy: slow, progressive deterioration over months to years 5

Red Flags Requiring Urgent Evaluation

• Rapid progression of symptoms 3
• Bowel or bladder incontinence (suggests severe compression) 2
• Severe pain 3
• Fever (suggests infectious etiology) 3
• History of cancer (suggests metastatic disease) 5

Early recognition of myelopathy signs is crucial as delayed diagnosis can lead to irreversible neurological damage. MRI of the spine should be performed promptly when myelopathy is suspected to identify the cause and guide appropriate treatment 1, 3.