Synopsis
Recognise cervical spinal-cord dysfunction early, distinguish it from nerve-root and peripheral disorders, and match adult degenerative disease severity to safe specialist management.
- Cervical myelopathy is spinal-cord dysfunction: hand dexterity loss, gait imbalance and upper-motor-neuron leg signs distinguish it from a single cervical root lesion.
- Examine both arms and legs. A patient describing hand numbness may still have brisk knees, clonus, extensor plantar responses, proprioceptive loss and a broad-based or spastic gait.
- The worked case keeps context, reasoning, outcome and verification visible in Rapid mode, including the urgent MRI and referral decision.
Key red flags
Progressive hand weakness or clumsiness combined with gait deterioration or falls is a cord syndrome until assessed, even without neck pain.
New bladder or bowel dysfunction, saddle change, profound limb weakness or a defined sensory level requires emergency assessment rather than routine DCM follow-up.
Fever, immunosuppression, cancer history, severe night pain, recent procedure, trauma or anticoagulation changes the aetiology and urgency of cord compression.
Respiratory weakness, high cervical sensory change or rapidly ascending deficit requires immediate airway and critical-care planning.
Progressive loss of buttoning, handwriting or object grip together with gait change and upper-motor-neuron signs means suspected cervical myelopathy: arrange urgent spinal assessment and cervical MRI.
Unsteadiness, stiffness, falls, reduced tandem gait, brisk reflexes, clonus and extensor plantar responses support cervical cord dysfunction.
Reasoning priorities
Localise cord, root and peripheral components and establish a reproducible functional baseline.
Bilateral long-tract leg signs plus hand dysfunction support cervical myelopathy; a sensory level or rapid progression increases urgency.
Worked reasoning
An older adult develops months of buttoning difficulty, falls and brisk leg reflexes with no acute trauma.
- Context: document pace, hand tasks, walking distance, falls, sphincter symptoms, arm radicular pain and examination of cranial nerves, all limbs, reflexes, plantars, proprioception and gait.
- Reasoning: recognise the combined hand, gait and long-tract pattern as cervical myelopathy rather than isolated root or median-nerve disease; request cervical MRI and urgent specialist assessment.
- Outcome: if MRI confirms moderate or severe DCM, discuss decompression; choose anterior or posterior access and stabilisation from level count, compression location, alignment, instability and surgical risk.
- Verification: record baseline function and severity, then follow strength, dexterity, gait, sphincters, pain and complications; stability can be success because established cord injury may not fully reverse.