Clinical Features of Cervical Spinal Cord Compression
Cervical spinal cord compression most commonly presents with motor and sensory dysfunction, gait disturbances, and hand dexterity problems, requiring prompt diagnosis and treatment to prevent permanent neurological damage. 1
Common Clinical Manifestations
- Decreased hand dexterity - One of the hallmark symptoms, patients experience difficulty with fine motor tasks such as buttoning shirts, writing, or picking up small objects 2
- Gait instability and balance difficulties - Patients develop an unsteady, wide-based gait pattern that worsens as compression progresses 3, 2
- Quadriparesis or paraparesis - Progressive weakness in the extremities, with upper limbs often affected first in cervical compression 1
- Sensory dysfunction - Numbness, tingling, or paresthesias in the upper and/or lower extremities with a distribution pattern corresponding to the level of compression 4
- Neck pain - May be present but is not uniformly observed in all patients with cervical cord compression 4
- Bowel and bladder dysfunction - Often occurs in advanced cases, presenting as urinary retention, incontinence, or constipation 4
Specific Neurological Findings
- Hyperreflexia below the level of compression with positive Hoffman's sign and/or Babinski sign 2
- Clonus - Sustained rhythmic contractions when stretching specific muscle groups 1
- Lhermitte's sign - Electric-like sensation running down the spine upon neck flexion 1
- Romberg's sign - Inability to maintain balance with eyes closed while standing with feet together 3
- Myelopathic hand - Characterized by grip and release test abnormalities and intrinsic hand muscle wasting 2
Progression Patterns
- Insidious onset - Symptoms typically develop gradually over time as degenerative changes progress 2
- Variable progression - Some patients experience rapid deterioration while others have a more indolent course 5
- Stepwise deterioration - Periods of stability may be interrupted by episodes of acute worsening 1
Specific Patient Populations
- Achondroplasia patients - Present with unique features including respiratory difficulties (apnea/cyanosis in 48-85% of cases), bulbar dysfunction, and early-onset myelopathy 1
- Post-surgical patients - May develop compression due to seromas, pseudomeningoceles, hematomas, or epidural abscesses throughout the postoperative course 1
Diagnostic Considerations
- MRI findings - The gold standard for diagnosis, showing cord signal changes, compression patterns, and potential etiologies 1
- Cord signal changes on T2-weighted MRI - Hyperintensity within the cord represents myelomalacia and is a prognostic factor for surgical outcomes 1
- Spinal canal diameter - A narrow canal (<14.5 mm) combined with multi-level compression increases risk of neurological deterioration 5
- Cord swelling - Maximal cord swelling is an excellent predictor of neurological recovery potential after decompression 6
Clinical Pitfalls and Caveats
- Supine imaging limitations - MRI performed in the supine position may miss intermittent compression that occurs in the upright position 7
- Asymptomatic cord compression - Radiographic evidence of compression does not always correlate with clinical symptoms; 35% of achondroplasia patients have radiographic evidence without symptoms 1
- Delayed diagnosis - Despite being the most common form of spinal cord injury in adults, diagnosis is often delayed due to insidious onset and variable presentation 2
- Potential for catastrophic deterioration - Untreated cervicomedullary compression carries a mortality rate of up to 16% in specific populations 1