From the Guidelines
Acute myelopathy and acute radiculopathy are distinct neurological conditions that require different diagnostic and treatment approaches, with myelopathy often necessitating urgent intervention and radiculopathy typically being managed more conservatively. Acute myelopathy involves damage to the spinal cord itself, resulting in bilateral symptoms below the level of injury, including weakness, sensory changes, and bowel/bladder dysfunction, as noted in the 2021 update of the ACR Appropriateness Criteria for myelopathy 1. In contrast, acute radiculopathy affects a spinal nerve root as it exits the spinal column, causing unilateral pain, numbness, and weakness in the specific distribution of the affected nerve root. The distinction between these two conditions is crucial for proper diagnosis and timely treatment, as myelopathy often requires immediate MRI of the spine, while radiculopathy evaluation may begin with less urgent imaging, as suggested by the ACR Appropriateness Criteria for low back pain 1.
Key Differences
- Acute myelopathy: damage to the spinal cord, bilateral symptoms, urgent intervention often required
- Acute radiculopathy: damage to a spinal nerve root, unilateral symptoms, conservative management often appropriate
- Diagnostic workup: myelopathy typically requires immediate MRI of the spine, while radiculopathy evaluation may begin with less urgent imaging
Diagnostic Approaches
- MRI of the spine is the preferred imaging modality for evaluating suspected myelopathy, as it provides superior soft-tissue resolution and multiplanar capability 1
- For radiculopathy, imaging may not be necessary in the initial evaluation, and a focused history and physical examination, reassurance, and initial pain management medications may be sufficient, as recommended by the American College of Physicians and the American Pain Society 1
Treatment Approaches
- Myelopathy: urgent intervention, including possible surgical decompression, steroids for inflammation, or specific treatments for the underlying cause
- Radiculopathy: conservative management, including pain medications, physical therapy, and sometimes epidural steroid injections
Importance of Recognition
Recognizing the differences between acute myelopathy and acute radiculopathy is crucial for proper diagnosis and timely treatment, as delayed or inappropriate treatment can lead to significant morbidity and mortality, as emphasized by the ACR Appropriateness Criteria for myelopathy and low back pain 1.
From the Research
Definition and Characteristics
- Acute myelopathy is a spinal cord disorder characterized by a rapidly progressive course, reaching its nadir within hours to a few weeks, and may result in severe disability 2.
- Myelopathy is an inclusive term referring to pathology leading to a neurologic deficit related to the spinal cord, and its clinical diagnosis requires a detailed history and physical examination to define the clinical syndrome 3.
- Acute myelopathy is considered a diagnostic dilemma due to the heterogeneity in pathogenesis and the overlap in clinical and imaging presentation among etiologies 4.
Comparison with Acute Radiculopathy
- Acute radiculopathy is not explicitly defined in the provided studies, but it can be inferred that it refers to a condition affecting the nerve roots, as opposed to the spinal cord in myelopathy.
- A case report mentions cervical transforaminal epidural steroid injection (TFESI) as a treatment for cervical radiculopathy, but it resulted in acute cervical myelopathy with quadriparesis, highlighting the potential for complications and the importance of distinguishing between the two conditions 5.
Diagnosis and Management
- Neuroimaging plays a vital role in the diagnosis of myelopathy, helping to distinguish between compressive and intrinsic etiologies, and guiding treatment decisions 2, 3.
- A simplified approach for the differential diagnosis among all causes of acute myelopathies is useful, considering the broad spectrum of etiologies and the overlap in clinical and imaging presentation 4.
- Treatment strategies for acute myelopathy depend on the underlying cause, and may include medical treatment, surgery, or conservative management, such as medication and rehabilitation 5, 6.