Symptoms of Cervical Myelopathy
Cervical myelopathy presents with a characteristic combination of upper and lower extremity dysfunction, gait disturbance, and loss of fine motor control that progressively worsens without treatment. 1, 2
Motor Symptoms
Upper Extremity Manifestations
- Hand clumsiness and loss of fine motor dexterity are hallmark early symptoms, making tasks like buttoning shirts or handling small objects difficult 3
- Weakness in specific muscle groups of the arms, often affecting grip strength and hand intrinsic muscles 4, 3
- Muscle atrophy may develop in advanced cases, particularly in the hands 2
Lower Extremity Manifestations
- Generalized weakness or stiffness in the legs is a cardinal feature of myelopathy 4
- Spasticity develops as upper motor neuron dysfunction progresses 3
- Hyperreflexia is commonly observed on examination 5, 3
Sensory Symptoms
- Numbness and paresthesias in the upper extremities, often described as tingling or "pins and needles" sensation in the hands and arms 1, 3
- Pain radiating down the arms when radiculopathy coexists with myelopathy 4
- Sensory abnormalities affecting proprioception and vibration sense 3
Gait and Balance Disturbances
- Gait difficulties and disequilibrium are prominent features that significantly impact quality of life 5, 3
- Patients often describe an unsteady, wide-based gait pattern 2
- Balance problems increase fall risk and functional limitations 3
Bladder and Bowel Dysfunction
- Difficulty with bladder control, ranging from urgency to frank incontinence in severe cases 1, 3
- Bowel dysfunction may occur but is less common than bladder symptoms 1
Neck-Related Symptoms
- Neck pain and stiffness with decreased cervical range of motion 4, 3
- Neck symptoms may be mild or absent despite significant spinal cord compression 3
Disease Progression Patterns
The natural history is variable but generally follows one of three patterns 6:
- Episodic deterioration (75% of patients): New symptoms appear in discrete episodes with quiescent intervals between, though 2/3 of patients show gradual deterioration even during "stable" periods 6
- Slow steady progression (20% of patients): Gradual worsening without stepwise decline 6
- Rapid onset followed by plateau (5% of patients): Acute symptom development that then stabilizes 6
Severity Classification
Mild myelopathy (mJOA score >12) may remain stable in approximately 70-80% of patients over 3 years with conservative management, though 20-30% will progress and require surgery 6
Moderate to severe myelopathy (mJOA score ≤12) demonstrates progressive neurological deterioration without surgical intervention and requires decompression 6, 7
Critical Warning Signs
- Progressive quadriparesis indicates severe spinal cord compromise requiring urgent surgical evaluation 1
- Development of incontinence signals advanced disease 1
- Rapid symptom progression over weeks to months warrants immediate neurosurgical consultation 8
Common Pitfalls in Recognition
Early cervical myelopathy is frequently missed because symptoms can be subtle and attributed to normal aging, peripheral neuropathy, or other conditions 1, 3. The combination of upper extremity fine motor loss with lower extremity gait disturbance should always raise suspicion for myelopathy 3.
Female sex, older age, and increased cervical range of motion are associated with worse natural history outcomes 6. Prolonged symptom duration before diagnosis correlates with poorer surgical outcomes, emphasizing the importance of early recognition 7, 8.