Can cervical spondylosis with radiculopathy and central canal stenosis cause fatigue in a 62-year-old patient?

Can Cervical Spondylosis with Radiculopathy and Central Stenosis Cause Fatigue in a 62-Year-Old Patient?

Yes, cervical spondylosis with radiculopathy and central stenosis can cause fatigue in a 62-year-old patient, particularly when there is underlying spinal cord compression or myelopathy, though fatigue is not a typical primary symptom of isolated radiculopathy.

Understanding the Relationship Between Cervical Pathology and Fatigue

Primary Clinical Presentations

The typical manifestations of cervical spondylosis with radiculopathy include:

• Neck and arm pain with dermatomal sensory loss, motor weakness, and reflex changes are the hallmark symptoms of cervical radiculopathy 1
• Neurological dysfunction from compression and inflammation of cervical nerve roots primarily presents with pain and focal neurological deficits rather than systemic fatigue 1

When Fatigue Becomes Relevant: The Myelopathy Connection

Fatigue can emerge as a significant symptom when cervical stenosis progresses to involve the spinal cord itself:

• Cervical spondylotic myelopathy (CSM) represents spinal cord compression that can produce more global symptoms beyond isolated radicular pain 2
• Severe ME/CFS symptoms, including profound fatigue, have been documented to improve following surgical decompression of cervical spinal stenosis in patients with cord compression, suggesting that cervical stenosis can contribute to systemic fatigue symptoms 3
• Three consecutive patients with severe chronic fatigue syndrome and cervical spinal stenosis experienced marked improvement in global fatigue symptoms following anterior cervical decompression surgery, with restoration of more normal function 3

Critical Diagnostic Distinction

The presence of central stenosis in your 62-year-old patient warrants careful evaluation for myelopathy:

• Gait and balance difficulties, bowel/bladder dysfunction, or fine motor impairment indicate cervical myelopathy rather than isolated radiculopathy 2
• Physical examination findings including hyperreflexia (>3+ deep tendon reflexes), positive Hoffman sign, tremor, or absent gag reflex suggest myelopathic involvement that could explain systemic symptoms like fatigue 3
• The modified Japanese Orthopaedic Association (mJOA) scale score ≤12 indicates moderate to severe myelopathy requiring urgent surgical consideration 2

Clinical Algorithm for Evaluating Fatigue in This Context

Step 1: Assess for Myelopathic Signs

• Perform detailed neurological examination looking specifically for hyperreflexia, Hoffman sign, clonus, gait instability, and fine motor dysfunction 3, 2
• Document any bowel/bladder incontinence or dysfunction, which represents advanced myelopathy 4

Step 2: Review Imaging for Cord Compression

• MRI is the gold standard for evaluating nerve root and spinal cord compression in cervical stenosis 5
• Look for canal diameter <10mm, spinal cord compression with effacement of subarachnoid space, and intramedullary T2 hyperintensity on MRI, which indicate significant cord involvement 4, 3
• Cervical spine canal diameters of 6-8.5mm have been associated with severe symptoms including fatigue that improved with surgical decompression 3

Step 3: Correlate Clinical and Radiographic Findings

• Imaging abnormalities must correlate with clinical symptoms, as asymptomatic degenerative changes are common in patients over 30 years 6, 2
• The combination of central stenosis on imaging plus clinical myelopathic signs provides the strongest evidence that cervical pathology is contributing to systemic symptoms like fatigue 3

Treatment Implications When Fatigue is Present

Conservative Management Limitations

• For isolated radiculopathy without myelopathy, 75-90% of patients improve with conservative treatment including physical therapy, anti-inflammatory medications, and activity modification 5
• However, when myelopathy is present (indicated by gait disturbance, hyperreflexia, or cord compression), conservative management is futile and surgical decompression should not be delayed 2

Surgical Intervention for Myelopathy

• Surgical decompression is strongly recommended for moderate to severe myelopathy (mJOA ≤12) and should not be delayed, as it provides sustained neurological improvement and prevents irreversible spinal cord damage 2
• Approximately 97% of patients experience some recovery of symptoms after surgery for cervical stenosis with myelopathy 2
• Resolution of fatigue and orthostatic symptoms has been documented following anterior cervical decompression in patients with severe stenosis, with prompt post-surgical restoration of more normal function 3

Critical Pitfalls to Avoid

• Do not dismiss fatigue as unrelated to cervical pathology when central stenosis is present—carefully evaluate for myelopathic signs that would explain systemic symptoms 3
• Do not delay surgery waiting for "failed conservative management" in a patient with established myelopathy and gait disturbance, as this risks permanent neurological deficit 2
• Do not assume all imaging abnormalities are symptomatic—correlation with clinical examination is essential, as asymptomatic cervical stenosis is common in middle-aged and elderly patients 6, 7
• Do not overlook subtle myelopathic findings such as hyperreflexia or positive Hoffman sign, especially when patients present with atypical symptoms like profound fatigue 3

Bottom Line for Your 62-Year-Old Patient

If your patient has isolated radiculopathy without myelopathic signs, fatigue is unlikely to be directly caused by the cervical pathology and other etiologies should be investigated. However, if central stenosis is causing spinal cord compression with myelopathic features (hyperreflexia, gait instability, cord signal changes on MRI), then fatigue can indeed be a manifestation of the cervical pathology and may improve with surgical decompression 3, 2. The key is performing a thorough neurological examination and correlating findings with MRI evidence of cord compression 5, 3.