Myelopathy 721.91

synonyms:

Myelopathy ICD-9

• 721.91 Spondylosis w tih myelopathy

Myelopathy Etiology / Epidemiology / Natural History

• Compression of the spinal cord from herniated disk, osteophytes, redundant ligamentum flavum, ossified PLL(more common in Asians)

Myelopathy Anatomy

Myelopathy Clinical Evaluation

• Clumsiness, los of coordination, loss of fine motor skills, stiff gait, balance disturbance, numbness/buring in hands/feet, urninary retention, incontinence (rare)
• Fine motor skills: tying shoes, buttoning buttons, handwriting
• Symptoms are often subtle.
• Upper and lower extremity NV exam.
• DTRs typically increased.
• Long Track signs indicate myelopathy
  -Babinski's Reflex: upturning and splaying of the toes with plantar stimulus
  -Hoffman's sign: flexion of the thumb and index fingers in response to flicking the tip of the outstretched middle finger
  -Lhermitte's sign: shooting sensations down the arm with rapid neck flexion.
  -Inverted Radial reflex: decreased brachioradialis reflex with concomitant flexion of all fingers.
  -Clonus

Myelopathy Xray / Diagnositc Tests

• A/P, Lateral, Odontoid, flexion / extention lateral views. Evaluated for instability, pseudarthrosis, atlantoaxial arthrosis.
• MRI: typically reveals area of compression.

Myelopathy Classification / Treatment

• Due to risks fof progression and possibly irreversible neurologic deficits treatment is generally surgical dempression.
• Surgical Options: Laminectomy, laminoplasty, ACDF (anterior diskectomy and fusion) +/- corpectomy.

Myelopathy Associated Injuries / Differential Diagnosis

• Carpal tunnel syndrome
• Cubital tunnel syndrome
• Thoracic outlet syndrome
• Myelopathy
• Cauda Equina Syndrome
• Lumbar HNP
• Thoracic HNP

Myelopathy Complications (ACDF)

• Recurrent laryngeal nerve palsy (more common with right sided anterior approaches)
• Horner's syndrome (sympathetic chain neuropraxia)
• Dysphagia
• Dysphonia
• Vertebral artery injury
• Pseudoarthrosis
• Adjacent segment degeneration

Myelopathy Follow-up Care

Myelopathy Review References

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