What is the diagnosis and treatment for idiopathic cervical myelopathy in a male adult from India?

From the Guidelines

Idiopathic cervical myelopathy in an adult male from India requires prompt neurological evaluation and treatment, with the recommended approach including MRI imaging of the cervical spine to confirm diagnosis and assess severity, followed by consultation with a neurosurgeon or spine specialist. The initial management typically involves cervical collar immobilization to prevent further spinal cord damage. For mild cases, conservative treatment with physical therapy, anti-inflammatory medications like methylprednisolone (initial dose of 30mg/kg IV followed by 5.4mg/kg/hr for 23 hours) or oral prednisolone (starting at 60mg daily with tapering), and neuropathic pain medications such as pregabalin (75-150mg twice daily) or gabapentin (300mg three times daily) may be appropriate, as suggested by the American College of Radiology Appropriateness Criteria 1.

Key Considerations

• The condition involves compression of the spinal cord in the neck region, causing symptoms like weakness, numbness, and coordination problems, with potential genetic and environmental factors possibly contributing to its higher prevalence in Asian populations, including India.
• MRI is the preferred modality for evaluating myelopathy due to its superior soft-tissue resolution and multiplanar capability, allowing for the evaluation of the spinal canal and its contents as well as the surrounding osseous and soft-tissue structures 1.
• In patients who have undergone spinal surgery, extrinsic compression of the spinal cord can develop throughout the postoperative course and may be secondary to seromas, pseudomeningoceles, hematomas, and/or epidural abscesses 1.
• For moderate to severe cases with progressive neurological deficits, surgical decompression is often necessary, with anterior cervical discectomy and fusion (ACDF) or laminoplasty being common procedures.
• Post-treatment rehabilitation is essential and should include physical therapy focusing on gait training and strengthening exercises.
• Regular follow-up with neurological examinations every 3-6 months is important to monitor for disease progression.

Treatment Approach

• Initial management: cervical collar immobilization, physical therapy, anti-inflammatory medications, and neuropathic pain medications.
• Moderate to severe cases: surgical decompression with ACDF or laminoplasty.
• Post-treatment rehabilitation: physical therapy focusing on gait training and strengthening exercises.
• Regular follow-up: neurological examinations every 3-6 months to monitor for disease progression, as recommended by the American College of Radiology Appropriateness Criteria 1.

From the Research

Idiopathic Cervical Myelopathy in Male Adults from India

There is limited information available on idiopathic cervical myelopathy in male adults from India. However, the following points can be noted:

• Cervical spondylotic myelopathy (CSM) is a neurologic condition that develops insidiously over time as degenerative changes of the spine result in compression of the cord and nearby structures 2.
• The hallmark symptoms of CSM include decreased hand dexterity and gait instability as well as sensory and motor dysfunction 2.
• Magnetic resonance imaging (MRI) is the imaging modality of choice in patients with suspected CSM, but computed tomography myelography may be used in patients with contraindications 2.
• Dynamic MRI can be a useful tool in the treatment of CSM patients, especially in surgical decision making 3.
• The presence of an intramedullary gadolinium-enhancement with a flat transverse pancake-like pattern (on sagittal images) and a circumferential pattern (on axial images), located within a T2-signal abnormality, in patients with cervical spondylosis and clinical myelopathy is indicative of spondylosis as the cause of the myelopathy 4.
• Treatment options for cervical myelopathy are focused on decompression of the spinal canal from an anterior, posterior, or combined anterior and posterior surgical approach depending on the location of compression and patient factors 5.
• Degenerative cervical myelopathy (DCM) is the most common and serious neurological disorder in the elderly population caused by chronic progressive compression or irritation of the spinal cord in the neck 6.

Key Points to Consider

• Idiopathic cervical myelopathy is a clinical syndrome caused by compression of the spinal cord between the levels of the C1 and T1 vertebrae.
• Diagnosis is confirmed with appropriate imaging studies carefully correlated with history and physical examination.
• Treatment options are focused on decompression of the spinal canal from an anterior, posterior, or combined anterior and posterior surgical approach depending on the location of compression and patient factors.
• Outcomes are favorable if treatment is performed prior to severe symptom onset.

Imaging and Diagnosis

• MRI is the imaging modality of choice in patients with suspected CSM.
• Dynamic MRI can be a useful tool in the treatment of CSM patients, especially in surgical decision making.
• The presence of an intramedullary gadolinium-enhancement with a flat transverse pancake-like pattern (on sagittal images) and a circumferential pattern (on axial images), located within a T2-signal abnormality, in patients with cervical spondylosis and clinical myelopathy is indicative of spondylosis as the cause of the myelopathy.