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Degenerative cervical myelopathy
Degenerative narrowing of the cervical canal compresses the spinal cord and causes clumsy hands, unsteady gait and upper motor neuron signs; the disease usually progresses gradually, so moderate or severe myelopathy is treated with surgical decompression.
Why it matters in the exam
The typical stem describes a person over 55 who has difficulty buttoning a shirt and writing, drops objects and feels as if walking drunk, sometimes with mild neck pain or none at all. Examination shows brisk reflexes, a positive Hoffmann sign, a Babinski sign, clonus and sometimes the Lhermitte sign — an electric shock sensation down the back on neck flexion. Distinguishing it from cervical radiculopathy matters: radiculopathy causes pain and weakness in the distribution of one root with a reduced reflex, whereas in myelopathy findings are bilateral and point to injury of the cord itself. Other differentials include multiple sclerosis, ALS, vitamin B12 deficiency and carpal tunnel syndrome, which mimics the hand symptoms but does not cause gait disturbance or brisk reflexes. MRI shows the level of compression and sometimes a signal change within the cord. The treatment decision rests on severity, measured with the mJOA scale: in moderate or severe disease, and in progressive disease, surgery is recommended, because conservative care does not stop progression; in mild disease surgery or close monitoring with structured rehabilitation are both options. Surgery is done by an anterior approach (discectomy and fusion, or corpectomy) or a posterior approach (laminoplasty, or laminectomy and fusion), depending on the number of levels and spinal alignment. The main aim of surgery is to stop deterioration; partial improvement is common, but long-standing damage may remain. In an older adult with known stenosis, even minor trauma can cause acute cord injury, so the patient should be told about this risk.
Key points
- Clumsy hands, gait disturbance and upper motor neuron signs.
- Hoffmann sign, Babinski, brisk reflexes and Lhermitte sign.
- MRI confirms cord compression.
- Moderate or severe — surgical decompression.
- Differential: multiple sclerosis, ALS and B12 deficiency.
Summary table
| Severity (mJOA) | Findings | Recommendation |
|---|---|---|
| Mild | Mild clumsiness or examination findings only | Surgery or close monitoring with structured rehabilitation |
| Moderate | Clear impairment of hand function or gait | Surgical decompression |
| Severe | Marked gait disturbance, dependence on help | Prompt surgical decompression |
| Stenosis without myelopathy | MRI finding without symptoms or signs | Observation and advice on warning signs; no routine prophylactic surgery |
| Progressive disease | Deterioration on repeated examination | Surgery, even if severity is mild |
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Sources
- AO Spine / CSRS Clinical Practice Guideline, 2017 — Management of Degenerative Cervical Myelopathy
- Campbell's Operative Orthopaedics, 14th ed. (2021) — Degenerative Disorders of the Cervical Spine
Sources are given for further reading; the text is written afresh and not copied from them.
Reviewed by the Examqo AI Professor · 2026-11-06. The text may contain errors; when in doubt, check the source.