Practice Easily Missed?

Degenerative cervical myelopathy

BMJ 2018; 360 doi: https://doi.org/10.1136/bmj.k186 (Published 22 February 2018) Cite this as: BMJ 2018;360:k186
  1. Benjamin M Davies, academic clinical fellow and specialist registrar neurosurgery1,
  2. Oliver D Mowforth, medical student,1,
  3. Emma K Smith, specialist registrar general practice,2,
  4. Mark RN Kotter, clinician scientist, and consultant neurosurgeon1
  1. 1Academic neurosurgery unit, Department of Clinical Neurosurgery, University of Cambridge, Cambridge, UK
  2. 2School of General Practice, NHS Health Education East of England, UK
  1. Correspondence to MRN Kotter mrk25{at}cam.ac.uk

What you need to know

  • Consider degenerative cervical myelopathy in patients over 50 with progressive neurological symptoms, such as pain and stiffness in the neck or limbs, imbalance, numbness, loss of dexterity, frequent falls, and/or incontinence

  • Perform a full neurological assessment as early symptoms are subtle and non-specific

  • A magnetic resonance imaging (MRI) scan is essential to detect degenerative changes in the cervical spine and cord compression

  • Time is Spine: Refer patients with suspected DCM promptly to a specialist for consideration of spinal surgery, as delayed diagnosis can lead to residual symptoms and functional disability

A 54 year old man presents with neck stiffness for about a year. He complains of numbness in his fingers and difficulty buttoning up his shirt, which has not improved following surgery for carpal tunnel syndrome. Of late, he has experienced unsteadiness and has started to use a walking stick after sustaining falls. He sees a neurologist who identifies hyperreflexia in his arms and legs. An MRI scan shows multilevel cervical spondylosis and disc herniation causing cord compression. He is diagnosed with degenerative cervical myelopathy and referred to spinal surgery for operative decompression.

What is degenerative cervical myelopathy?

Degenerative cervical myelopathy (DCM), earlier referred to as cervical spondylotic myelopathy, involves spinal cord dysfunction from compression in the neck.1 Patients report neurological symptoms such as pain and numbness in limbs, poor coordination, imbalance, and bladder problems. Owing to its mobility, the vertebral column of the neck is particularly prone to degenerative changes such as disc herniation, ligament hypertrophy or ossification, and osteophyte formation. These changes are more common with age2 (box 1) and are often collectively termed spondylosis (fig 1).3

Box 1

How common is it?

The epidemiology of DCM is poorly understood, in part because of the difficulties in diagnosis.3

  • The prevalence of surgically treated DCM is estimated as 1.6 per 100 000 inhabitants.4 The actual …

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