Cervical myelopathy: diagnosing another great impostor

Area of Science:

• Neurology
• Clinical Diagnostics
• Spinal Cord Medicine

Background:

• Cervical myelopathy presents diagnostic challenges, often mimicking other conditions, leading to delays.
• Delayed diagnosis can result in irreversible neurological deficits like paralysis and dysfunction.
• Military clinicians must maintain a high index of suspicion for cervical myelopathy in all age groups.

Purpose of the Study:

• To provide an evidence-based update on diagnostic tools for cervical myelopathy.
• To review the utility of both established and emerging clinical diagnostic methods.

Main Methods:

• Systematic literature search of PubMed, CINAHL, and SPORTDiscus databases.
• Inclusion of English language, peer-reviewed articles.
• Focus on clinical diagnostic tools and imaging modalities.

Main Results:

• Traditional tests like Hoffmann and Babinski signs have limited utility.
• Trömner and Wazir hand signs demonstrate high sensitivity for C5-C6 level myelopathy.
• Lower extremity reflexes (patellar tendon, Rossolimo) and lateral cervical radiography are crucial for ruling out myelopathy and identifying stenosis.
• T1-weighted MRI findings correlate with surgical outcomes.

Conclusions:

• Military clinicians should employ validated clinical tools for cervical myelopathy diagnosis.
• Integrating sensitive physical exam maneuvers and appropriate imaging enhances diagnostic accuracy.
• Early and accurate diagnosis is critical to prevent severe neurological sequelae.