Myelopathy
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About Myelopathy
Myelopathy refers to a dysfunction of the long tracts of the spinal cord. Myelopathy develops in 5-10 percent of patients with symptomatic stenosis (spondylosis) of the cervical spine. Syndromes of cervical spondylotic myelopathy include transverse syndrome, motor system syndrome, mixed radicular and long tract syndrome, partial Brown-Sequard syndrome, and central cord syndrome. Central cord syndrome frequently occurs with minor trauma, especially involving neck hyperextension typically after a fall or other traumatic incident.
Symptoms: Myelopathy may manifest as weakness and spasticity, sensory loss, position sense loss, and incontinence.
Diagnosis: Myelopathy is usually first diagnosed by both history and physical examination. Patients frequently notice progressive deterioration in their hand and gait function. Physical examination commonly elicits long tract signs such as spasticity, hyperreflexia, and abnormal reflexes such as Babinski or Hoffman's sign. The diagnosis is confirmed by the presence of significant spinal cord compression as demonstrated by MRI or CT myelogram.
Treatment: Surgical decompression of the spinal cord is the best treatment for most cases of symptomatic myelopathy. It can be accomplished from either the front or the back of the spine, depending on the particular patient's situation. Commonly, a fusion procedure is performed concurrently, which minimizes the development of deformity and preserves the desired spinal alignment.
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