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Cervical Spondylotic Myelopathy – Clinical Pattern — SCE Neurology MCQ

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ModerateNeurorehabilitationCervical Spondylotic Myelopathy – Clinical PatternSCE Neurology

A 45-year-old woman presents with a 6-month history of progressive bilateral hand numbness and clumsiness. She drops objects frequently. She also has neck pain. Examination shows bilateral wasting of intrinsic hand muscles, hyperreflexia in all four limbs, and bilateral extensor plantar responses. Sensation is intact. MRI cervical spine shows multi-level cervical spondylosis with spinal cord compression at C4/5 and C5/6 with cord signal change on T2. What clinical sign combination is characteristic of cervical spondylotic myelopathy?

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Correct answer: A — Lower motor neurone signs in the arms with upper motor neurone signs in the legs

Cervical spondylotic myelopathy characteristically produces a mixed picture: lower motor neurone signs at the level of compression (due to damage to anterior horn cells and nerve roots — hand wasting, reduced arm reflexes at the affected level) and upper motor neurone signs below the level of compression (due to corticospinal tract compression — spastic legs, brisk leg reflexes, extensor plantars). This LMN-at-level + UMN-below pattern is the hallmark of any compressive myelopathy. B: Isolated LMN signs suggest nerve root or anterior horn cell pathology. C: UMN signs in the arms would suggest a higher lesion. D: LMN in the legs suggests a conus/cauda lesion. E: This pattern suggests a lower spinal cord or motor neurone disease.

Reference: AO Spine Cervical Myelopathy Guidelines (2020); ABN Myelopathy Guidelines