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Cervical Myelopathy – Segmental Pattern — SCE Neurology MCQ

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ModerateCerebrovascular DiseaseCervical Myelopathy – Segmental PatternSCE Neurology

A 60-year-old man presents with progressive gait difficulty. Examination reveals bilateral upper motor neurone signs in the legs (spastic gait, brisk reflexes, extensor plantars) and lower motor neurone signs at the level of C5–C6 (wasting and weakness of biceps, reduced biceps reflex bilaterally). Sensation is intact. MRI cervical spine shows multilevel cervical spondylosis with cord compression at C5/6 and T2 cord signal change. What pattern of motor signs is characteristic of this lesion?

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Correct answer: D — LMN signs at the level of cord compression (C5/6 — from anterior horn cell damage) combined with UMN signs below the level of compression (legs — from corticospinal tract damage)

Compressive cervical myelopathy produces a characteristic 'segmental' pattern: LMN signs at the level of compression (due to anterior horn cell damage at C5/6 — biceps wasting, reduced biceps reflex) and UMN signs below the level (from corticospinal tract compression — spastic legs, brisk knee/ankle reflexes, extensor plantars). This LMN-at-level + UMN-below pattern localises the lesion precisely. A: UMN signs would not be at the level of compression. C: LMN signs below the lesion would indicate a more extensive process. D: Significant neurological signs are present. E: UMN signs are below, not above, the lesion; LMN at level, not below.

Reference: AO Spine Guidelines; Clinical Neuroanatomy