Synopsis
Detect degenerative cervical cord dysfunction before irreversible hand, gait and sphincter disability, distinguish it from radiculopathy and peripheral disease and expedite specialist decompression assessment.
- Degenerative cervical myelopathy results from static and dynamic cord compression by discs, osteophytes, ligament thickening, facet change or ossification within a developmentally narrow canal.
- Early symptoms are often loss of hand dexterity, dropping objects, difficulty with buttons or handwriting, bilateral paraesthesia and an unsteady or stiff-legged gait rather than severe neck pain.
- Examination may show hyperreflexia below the lesion, Hoffmann sign, inverted supinator response, ankle clonus, extensor plantars, impaired tandem gait and proprioceptive loss.
Key red flags
Buttons, coins, keys, handwriting, cutlery and phone use become slow or unreliable, objects are dropped and both hands may feel numb or stiff despite little neck pain.
Investigation priorities
Demonstrate cord compression, level, canal reserve, intramedullary signal and alternative tumour, infection or inflammatory disease.
Management branches
Hand clumsiness, gait change or bilateral symptoms accompany brisk reflexes, plantars or mixed arm and leg signs.
- Document dexterity, segmental strength, all limb reflexes, plantar responses, sensory modalities, gait and bladder or bowel symptoms and ask how quickly function is changing.
- Arrange urgent cervical MRI and specialist spinal referral; use emergency pathways for rapid decline, trauma, loss of walking or new sphincter dysfunction.
Key medicines
No disease-reversing tabletThere is no oral dose that decompresses the cervical cord or substitutes for surgical assessment.
Simple and anti-inflammatory analgesiaUse the lowest effective formulary dose for the shortest appropriate period after individual risk assessment.