Spine Degenerative Disease by Dr Azizul Akram B Salim

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?

What anatomical structure can be affected in cervical myelopathy?

Which condition is NOT listed as a common cause of myelopathy?

What is a common finding in patients with cervical myelopathy during the grip and release test?

Which reflex is commonly inverted in lower cervical myelopathy?

What is the purpose of the Hoffmann's sign test in evaluating patients with suspected myelopathy?

Which symptom may indicate late progression in cervical myelopathy?

What finding in the physical examination is characteristic of lower extremity weakness in cervical myelopathy?

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?

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

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.