Cervical Myelopathy Diagnosis and Imaging

Clinical Presentation and Diagnosis

• The American College of Radiology recommends examining for upper motor neuron signs, such as hyperreflexia, Babinski sign, clonus, and spasticity, when encountering bilateral feet paresthesia 4
• Hyperreflexia or preserved reflexes, rather than areflexia, are characteristic of cervical myelopathy, distinguishing it from peripheral polyneuropathy 1, 2
• Gait involvement is present in 100% of cervical myelopathy cases, with paresthesias and proprioceptive changes in a pattern that may not subside between episodes 1, 2, 3
• Assessing gait and balance for ataxia or spasticity is crucial in diagnosing cervical myelopathy 1, 2

Imaging and Diagnostic Algorithm

• The American College of Radiology designates cervical spine MRI as "usually appropriate" for acute or chronic myelopathy evaluation, providing superior visualization of the spinal cord, canal stenosis, and intramedullary signal changes 4, 7
• MRI of the cervical spine without and with contrast is the definitive imaging modality for evaluating suspected cervical myelopathy 4, 7
• Intramedullary T2 signal changes on MRI represent myelomalacia and gliosis, serving as prognostic factors for surgical outcomes 7