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Questions and Answers
What is the most prevalent type of myelopathy?
What are common symptoms of myelopathy?
What is a common cause of cervical myelopathy?
Which of the following is NOT a symptom of cervical myelopathy?
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What anatomical structure can be affected in cervical myelopathy?
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Which condition is NOT listed as a common cause of myelopathy?
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What is a common finding in patients with cervical myelopathy during the grip and release test?
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Which reflex is commonly inverted in lower cervical myelopathy?
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What is the purpose of the Hoffmann's sign test in evaluating patients with suspected myelopathy?
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Which symptom may indicate late progression in cervical myelopathy?
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What finding in the physical examination is characteristic of lower extremity weakness in cervical myelopathy?
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Which test is positive in patients with cervical myelopathy when extreme cervical flexion causes electric shock-like sensations radiating down the spine and into the extremities?
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Study Notes
Spine Degenerative Diseases
Myelopathy
- Definition: Neurologic impairment caused by disorder or pathology of spinal cord
- Types: Cervical, thoracic, lumbar myelopathy (cervical myelopathy is the most prevalent)
- Symptoms:
- Pain, tingling, numbness or weakness
- Difficulty in fine motor skills, abnormal or increased reflexes
- Difficulty walking, urinary and rectal incontinence or dysfunction
- Issue with balance and coordination (symptoms depend on location)
- Common causes:
- Disc herniation
- Degenerative cervical spondylosis
- Congenital stenosis
- Ossification of posterior longitudinal ligament (OPLL)
- Tumour
- Epidural abscess
- Trauma
- Cervical kyphosis
- Neurologic injury:
- Direct cord compression
- Ischaemic injury secondary to compression of anterior spinal artery
Cervical Myelopathy
- Caused by compression of the cervical spinal cord most commonly due to degenerative cervical spondylosis
- Symptoms:
- Neck pain and stiffness
- Occipital headache
- Extremity paraesthesia (diffuse, bilateral, non-dermatomal numbness and tingling)
- Weakness and clumsiness
- Gait instability
- Urinary retention (rare, late progression)
Physical Examination
- Motor Weakness:
- Difficult to detect on physical examination
- Lower extremity weakness – more concerning finding
- Finger escape sign
- Grip and release test
- Sensory:
- Proprioception dysfunction (DCML)
- Decreased pain/temp sensation (Lateral spinothalamic tract)
- Vibratory changes (severe case of long-standing myelopathy)
- Upper Motor Neuron Signs:
- Hyperreflexia
- Inverted radial reflex
- Scapulohumeral reflex
- Hoffmann’s sign
- Sustained clonus
- Babinski test
- Gait and Balance:
- Broad-based gait
- Tandem gait test
- Romberg test
- Provocative Test:
- Lhermitte Sign Test
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Description
Test your knowledge on spine degenerative diseases supervised by Dr Azizul Akram B Salim. This quiz covers topics such as myelopathy, radiculopathy, spondylolisthesis, and spinal stenosis among others.
