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Cervical myelopathy — MRCP Part 1 MCQ

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HardSpineCervical myelopathyMRCP Part 1

A 47-year-old has progressive hand clumsiness, gait imbalance, brisk lower-limb reflexes and impaired tandem walking. Which next investigation is most appropriate?

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Correct answer: A — Cervical MRI with cord-compression assessment

The best answer is “Cervical MRI with cord-compression assessment”. Upper-motor-neuron signs with hand dysfunction and gait disturbance suggest degenerative cervical myelopathy and potential spinal-cord compression. Urgent cervical MRI defines cord compression and specialist assessment prevents delay. Pain severity is not a reliable measure of neurological threat, and peripheral nerve studies do not replace cord imaging.

Reference: NICE NG127: Suspected neurological conditions: https://www.nice.org.uk/guidance/ng127/chapter/Recommendations