Postgraduate Medicine
ISSN: 0032-5481 (Print) 1941-9260 (Online) Journal homepage: http://www.tandfonline.com/loi/ipgm20
Cervical spondylotic myelopathy L. B. Lehman MD To cite this article: L. B. Lehman MD (1990) Cervical spondylotic myelopathy, Postgraduate Medicine, 88:3, 240-243, DOI: 10.1080/00325481.1990.11704741 To link to this article: http://dx.doi.org/10.1080/00325481.1990.11704741
Published online: 17 May 2016.
Submit your article to this journal
View related articles
Full Terms & Conditions of access and use can be found at http://www.tandfonline.com/action/journalInformation?journalCode=ipgm20 Download by: [Monash University Library]
Date: 03 July 2016, At: 15:18
-@CME credit article
Cervical spondylotic myelopathy A diagnostic challenge in aging patients
LB. Lehman, MD
Downloaded by [Monash University Library] at 15:18 03 July 2016
Preview Although cervical spondylotic myelopathy is a fairly common degenerative condition that typically occurs in middle-aged and elderly persons, it may be confused with such diseases as multiple sclerosis and amyotrophic lateral sclerosis. In this article, Dr Lehman describes the syndromes that are often seen with this condition, discusses medical and surgical treatment, and presents an illustrative case.
A 69-year-old former schoolteacher was referred to the neurosurgery clinics at Coney Island Hospital for evaluation of neck pain and slowly progressive difficulty in walking. He had had episodes ofleg spasms for several months and had not been able to walk unaided for 2 months. Occasionally, the neck pain radiated to his right shoulder and hand and was accompanied by numbness and paresthesias of the fingers of the right hand. He denied a history of peripheral vascular disease. Conventional radiographs of the cervical spine showed only diffuse degenerative changes and narrowed disk spaces. Electromyography and nerve conduction velocity studies detected changes localized to the midcervical region. A comprehensive neurologic examination was performed, and additional neurodiagnostic tests were requested. Further examination revealed upper and lower motor neuron findings localized to the cervical region. Magnetic resonance imaging (MRI) showed stenosis of the cervical spinal canal at a number oflevels and mild compression of the cervical spinal cord and exiting nerve roots. 240
Case discussion Deteriorating leg power and spasticity are parricularly troublesome in aging patients, whose ability to walk may already be limited by declining vision, poor coordination and balance, and other factors. Although these symptoms are fairly nonspecific, any new neurologic symptoms that arise warrant prompt assessment and diagnosis. Cervical spondylotic myelopathy is a degenerative process that occurs in middle-aged or older persons. Both upper and lower motor neuron signs are often present. Such activities of daily living as walking and performing routine hand and finger functions (eg, writing or opening a can or jar) become difficult. Most researchers )Jelieve that cervical spondylotic myelopathy results when the diameter of the cervical spinal canal is reduced by degenerative changes, including desiccation of cervical intervenebral disks and formation of chondro-osseous spurs along the posterior aspect of the vertebral bodies. This reduced diameter compromises the delicate microvasculature and may cause ischemic changes within the spinal cord
parenchyma and nerve roots. The natural history of untreated cervical spondylosis is quite variable, although evaluation with MRI or myelography is usually diagnostic. A number of excellent clinical reviews of the disease have been published. I-s Underlying causes range from purely mechanical to kinetic to neurovascular.H·9 Other conditions, such as multiple sclerosis, amyotrophic lateral sclerosis, transverse myelitis, spinal cord tumors, and vascular anomalies, are often confused with cervical spondylotic myelopathy and must be ruled out.
Syndromes Ferguson and Caplan5 have subdivided the diagnosis of cervical spondylosis into four fairly distinct syndromes: (I) a combined syndrome, (2) a purely myelopathic or medial syndrome, (3) a purely radiculopathic or lateral syndrome, and (4) a vascular syndrome. COMBINED-Clinically, this syndrome is the most common. Patients are typically men or women older than 50 years of age who repon clumsiness ano spasticity of both legs, diminished dexterity of the fingers, and paresthesias or numbness of the hands. A stooped, broad-based spastic gait is common. The neurologic examination may reveal ( 1) hyperreflexia in the legs and positive Babinski reflexes (signs of upper motor neuron disease) and (2) hyporeflexia and diminished power in the shoulder or arm muscles (signs oflower motor neuron continued
CERVICAL SPONDYLOSIS • VOL 88/NO 3/SEPTEMBER 1, 1990/POSTGRADUATE MEDICINE
BRIEF SUMMARY The fonawing is a brief summary only. Before prescribing, see complete IJOSCrlli'lg ~fonnatloo in Celoo• Tablets product tabeing
CONTRAINOICATIONS:
Ceftin• Tablets are contraindicated • pali..,ts Wlt!1 lo1own aleroy to lt'o cephal.,_;tl group of antOOIICs
WARNINGS:
BEFORE THERAPY WlTH CEFTIN" TABLETS IS INSTITUTED. CAREFUL INQUIRY SHOULD BE MADE TO DETERMINE WHETHER THE PATIENT K4S HAD PREVIOUS HYPERSENSrTMTY REACTIONS TO CEPHALOSPORINS, PENICILLINS, OR OTHER DRUGS. THIS PRODUCT SHOULD BE GIVEN CAUTIOUSLY TO PENICILLIN-SENSITIVE PATIENTS. ANTIBIOTICS SHOULD BE ADMINISTERED WlTH CAUTION TO Alf'l PATIENT WHO K4S DEMONSffiATED SOME fORM Of ALLERGY. PARTICULARLY TO DRUGS. IF AN ALLERGIC REAC· TION TO CEFTIN TABLETS OCCURS, DISCONTINUE THE DRUG. SERIOUS ACUTE HYPERSENSITIVITY REACTIONS MAY REQUIRE EPINEPHRINE AND OTHER EMERGENCY MEASURES Puadomemllr.u)ll colllll has been reported wt1t1 1tle ae Df cepb•o""""' (llld lllfllf llroad-111- - ) : lfunton, n lllmportallf to
Cervical spondylotic myelopathy most likely results from degenerative changes that reduce the diameter of the cervical spinal canal.
--ltldfal_ln,.-owhod'"""'d-.lniiiiCidotfonwflfl
MlltiDIIc Ill.
Trelb'nent wtt11 bl'oad-spectnm antibiotics alter1 noonal nou of ltle eaton illd may pemit overgrowth of ctostrid1a. StodM!s ildicate that a toxil prodocelj by ClosJridium difticile is one primary cause or antibiotic-associated collis
Cholestyramine and cotestipol resins have been shown to bind the toxin t!vitro. Mid cases of coitls may respond to drug discontllualioo aione Moderate to severe cases should be managed with fk.Jid, electrolyte, and prolell supplementaOOn as lldicated. When the colitis Is oot releved by drug dascootl'luanon or when • is severe. Or1l vancomydn Is the treatment of choice lor illltbiotic-associaled pseudo· membranous colitis produced by Clostridium difficils. Other causes of coous shoUd 11so be coostdered.
Downloaded by [Monash University Library] at 15:18 03 July 2016
PRECAunONS: G_.: "an alerg~ reaction to Celtil• Tilfllets ocan. lt'o lfruO should be dlscontirued, and, K necessary, t!1e patient sllrud be treated with appropriate agents, eg, antihistamines, pressor amines, or cortiCSI!>'1lids. As with other antibiotics. pcolonged use of Ceftln Tablets may result in overgrowth of nonsusceptible organisms. If superinfection occurs dur1ng lhenpy, approflfiato measures sroukf be taken. Broad-speciJOOl anllliollcs slloukf be presatled wlt!1 cMoo for indMduals
wltllalistoryolcoltls llfllnn- tor l'lfloo1o: (Podlo1rk) Ceftin is only
availab~ on tablet form Durtng clinical trials. the ta~et was weU tolerated by children who could swalow lhe IJb6et whole. Chidren -...flo cannot swalow the tab'el 'lllfl of chidm1 (rlflge, "" to 28'11o across centss). Tills. the physician lfld pnnt shoUrf ascertain. JJeferJbly- stll ~ t!1e physician's ofle
ISSN: 0032-5481 (Print) 1941-9260 (Online) Journal homepage: http://www.tandfonline.com/loi/ipgm20
Cervical spondylotic myelopathy L. B. Lehman MD To cite this article: L. B. Lehman MD (1990) Cervical spondylotic myelopathy, Postgraduate Medicine, 88:3, 240-243, DOI: 10.1080/00325481.1990.11704741 To link to this article: http://dx.doi.org/10.1080/00325481.1990.11704741
Published online: 17 May 2016.
Submit your article to this journal
View related articles
Full Terms & Conditions of access and use can be found at http://www.tandfonline.com/action/journalInformation?journalCode=ipgm20 Download by: [Monash University Library]
Date: 03 July 2016, At: 15:18
-@CME credit article
Cervical spondylotic myelopathy A diagnostic challenge in aging patients
LB. Lehman, MD
Downloaded by [Monash University Library] at 15:18 03 July 2016
Preview Although cervical spondylotic myelopathy is a fairly common degenerative condition that typically occurs in middle-aged and elderly persons, it may be confused with such diseases as multiple sclerosis and amyotrophic lateral sclerosis. In this article, Dr Lehman describes the syndromes that are often seen with this condition, discusses medical and surgical treatment, and presents an illustrative case.
A 69-year-old former schoolteacher was referred to the neurosurgery clinics at Coney Island Hospital for evaluation of neck pain and slowly progressive difficulty in walking. He had had episodes ofleg spasms for several months and had not been able to walk unaided for 2 months. Occasionally, the neck pain radiated to his right shoulder and hand and was accompanied by numbness and paresthesias of the fingers of the right hand. He denied a history of peripheral vascular disease. Conventional radiographs of the cervical spine showed only diffuse degenerative changes and narrowed disk spaces. Electromyography and nerve conduction velocity studies detected changes localized to the midcervical region. A comprehensive neurologic examination was performed, and additional neurodiagnostic tests were requested. Further examination revealed upper and lower motor neuron findings localized to the cervical region. Magnetic resonance imaging (MRI) showed stenosis of the cervical spinal canal at a number oflevels and mild compression of the cervical spinal cord and exiting nerve roots. 240
Case discussion Deteriorating leg power and spasticity are parricularly troublesome in aging patients, whose ability to walk may already be limited by declining vision, poor coordination and balance, and other factors. Although these symptoms are fairly nonspecific, any new neurologic symptoms that arise warrant prompt assessment and diagnosis. Cervical spondylotic myelopathy is a degenerative process that occurs in middle-aged or older persons. Both upper and lower motor neuron signs are often present. Such activities of daily living as walking and performing routine hand and finger functions (eg, writing or opening a can or jar) become difficult. Most researchers )Jelieve that cervical spondylotic myelopathy results when the diameter of the cervical spinal canal is reduced by degenerative changes, including desiccation of cervical intervenebral disks and formation of chondro-osseous spurs along the posterior aspect of the vertebral bodies. This reduced diameter compromises the delicate microvasculature and may cause ischemic changes within the spinal cord
parenchyma and nerve roots. The natural history of untreated cervical spondylosis is quite variable, although evaluation with MRI or myelography is usually diagnostic. A number of excellent clinical reviews of the disease have been published. I-s Underlying causes range from purely mechanical to kinetic to neurovascular.H·9 Other conditions, such as multiple sclerosis, amyotrophic lateral sclerosis, transverse myelitis, spinal cord tumors, and vascular anomalies, are often confused with cervical spondylotic myelopathy and must be ruled out.
Syndromes Ferguson and Caplan5 have subdivided the diagnosis of cervical spondylosis into four fairly distinct syndromes: (I) a combined syndrome, (2) a purely myelopathic or medial syndrome, (3) a purely radiculopathic or lateral syndrome, and (4) a vascular syndrome. COMBINED-Clinically, this syndrome is the most common. Patients are typically men or women older than 50 years of age who repon clumsiness ano spasticity of both legs, diminished dexterity of the fingers, and paresthesias or numbness of the hands. A stooped, broad-based spastic gait is common. The neurologic examination may reveal ( 1) hyperreflexia in the legs and positive Babinski reflexes (signs of upper motor neuron disease) and (2) hyporeflexia and diminished power in the shoulder or arm muscles (signs oflower motor neuron continued
CERVICAL SPONDYLOSIS • VOL 88/NO 3/SEPTEMBER 1, 1990/POSTGRADUATE MEDICINE
BRIEF SUMMARY The fonawing is a brief summary only. Before prescribing, see complete IJOSCrlli'lg ~fonnatloo in Celoo• Tablets product tabeing
CONTRAINOICATIONS:
Ceftin• Tablets are contraindicated • pali..,ts Wlt!1 lo1own aleroy to lt'o cephal.,_;tl group of antOOIICs
WARNINGS:
BEFORE THERAPY WlTH CEFTIN" TABLETS IS INSTITUTED. CAREFUL INQUIRY SHOULD BE MADE TO DETERMINE WHETHER THE PATIENT K4S HAD PREVIOUS HYPERSENSrTMTY REACTIONS TO CEPHALOSPORINS, PENICILLINS, OR OTHER DRUGS. THIS PRODUCT SHOULD BE GIVEN CAUTIOUSLY TO PENICILLIN-SENSITIVE PATIENTS. ANTIBIOTICS SHOULD BE ADMINISTERED WlTH CAUTION TO Alf'l PATIENT WHO K4S DEMONSffiATED SOME fORM Of ALLERGY. PARTICULARLY TO DRUGS. IF AN ALLERGIC REAC· TION TO CEFTIN TABLETS OCCURS, DISCONTINUE THE DRUG. SERIOUS ACUTE HYPERSENSITIVITY REACTIONS MAY REQUIRE EPINEPHRINE AND OTHER EMERGENCY MEASURES Puadomemllr.u)ll colllll has been reported wt1t1 1tle ae Df cepb•o""""' (llld lllfllf llroad-111- - ) : lfunton, n lllmportallf to
Cervical spondylotic myelopathy most likely results from degenerative changes that reduce the diameter of the cervical spinal canal.
--ltldfal_ln,.-owhod'"""'d-.lniiiiCidotfonwflfl
MlltiDIIc Ill.
Trelb'nent wtt11 bl'oad-spectnm antibiotics alter1 noonal nou of ltle eaton illd may pemit overgrowth of ctostrid1a. StodM!s ildicate that a toxil prodocelj by ClosJridium difticile is one primary cause or antibiotic-associated collis
Cholestyramine and cotestipol resins have been shown to bind the toxin t!vitro. Mid cases of coitls may respond to drug discontllualioo aione Moderate to severe cases should be managed with fk.Jid, electrolyte, and prolell supplementaOOn as lldicated. When the colitis Is oot releved by drug dascootl'luanon or when • is severe. Or1l vancomydn Is the treatment of choice lor illltbiotic-associaled pseudo· membranous colitis produced by Clostridium difficils. Other causes of coous shoUd 11so be coostdered.
Downloaded by [Monash University Library] at 15:18 03 July 2016
PRECAunONS: G_.: "an alerg~ reaction to Celtil• Tilfllets ocan. lt'o lfruO should be dlscontirued, and, K necessary, t!1e patient sllrud be treated with appropriate agents, eg, antihistamines, pressor amines, or cortiCSI!>'1lids. As with other antibiotics. pcolonged use of Ceftln Tablets may result in overgrowth of nonsusceptible organisms. If superinfection occurs dur1ng lhenpy, approflfiato measures sroukf be taken. Broad-speciJOOl anllliollcs slloukf be presatled wlt!1 cMoo for indMduals
wltllalistoryolcoltls llfllnn- tor l'lfloo1o: (Podlo1rk) Ceftin is only
availab~ on tablet form Durtng clinical trials. the ta~et was weU tolerated by children who could swalow lhe IJb6et whole. Chidren -...flo cannot swalow the tab'el 'lllfl of chidm1 (rlflge, "" to 28'11o across centss). Tills. the physician lfld pnnt shoUrf ascertain. JJeferJbly- stll ~ t!1e physician's ofle
