Cervical Myelopathy without Symptoms in the Upper Extremities: Incidence and Presenting Characteristics

• Published in: World neurosurgery 2019-12, Vol.132, p.e162-e168
• Main Authors: Houten, John K., Pasternack, Jordan, Norton, Robert P.
• Format: Article
• Language: English
• Subjects: Adult; Aged; Cervical myelopathy; Cervical spine surgery; Cervical Vertebrae - diagnostic imaging; Cervical Vertebrae - surgery; Decompression, Surgical; False localizing sign; Female; Humans; Hypesthesia - etiology; Incidence; Intervertebral Disc Degeneration - complications; Magnetic Resonance Imaging; Male; Middle Aged; Mobility Limitation; Muscle Weakness - etiology; Neurologic examination; Presenting symptoms; Retrospective Studies; Sensory level; Spinal cord; Spinal Cord Compression - diagnosis; Spinal Cord Compression - epidemiology; Spinal Cord Compression - surgery; Spinal Cord Diseases - diagnosis; Spinal Cord Diseases - epidemiology; Spinal Cord Diseases - surgery; Treatment Outcome; Upper Extremity
• ISSN: 1878-8750; 1878-8769
• DOI: 10.1016/j.wneu.2019.08.231

Common signs and symptoms of cervical myelopathy (CM) predominantly manifest in the upper extremities and include hand numbness, hand clumsiness, and distal upper extremity weakness. CM manifesting without symptoms in the upper extremities is rare. This study aimed to better understand the incidence and character of such cases. A retrospective review of surgeries for CM from disc herniation, spondylosis, or ossification of posterior longitudinal ligament over a 12-year period was performed to identify patients presenting without symptoms in the upper extremities. Of 982 surgically treated patients with CM, 12 (1.2%) had no upper extremity symptoms. All had difficulty ambulating, and 7 of 12 (58%) patients had objective lower extremity weakness. Ten (83%) patients had a history of lumbar degenerative disease. On sensory examination, 4 (33%) patients had a discernible midthoracic pin level, 3 (25%) had loss of sensation from the upper leg and genital area down, and 2 (17%) had only genital/upper thigh area sensory loss. All patients demonstrated neurologic improvement after decompressive surgery. Patients with CM may rarely present without symptoms in the upper extremities, presenting with numbness perceived from the upper trunk, waist area, or perineum and legs in addition to leg weakness and gait difficulty. All patients had cervical cord compression at either C5-6 or C6-7 level, accounting for 1% of all patients undergoing cervical surgery. Awareness of this atypical pattern of presentation may aid in clinical assessment of a subset of patients with cervical cord compression.