Myelopathy Exam

Look

 

Front

- appropriately disrobed / generalised disease / orthotics

 

Side

- sagittal alignment entire spine

 

Back

- wasting / lumbar spine coronal plane alignment / spinal dysraphism

 

Gait

 

Wide based gait

Heel Toe

 

Specific Tests

 

Rhomberg

- arms outstretched in front

- close eyes

- positive if lose balance once visual aids removed

 

Finger escape sign

- hold hands out, fingers together

- medial two fingers drift apart

- takes 30 – 60 seconds

 

Grip and Release / disdiadokinesis

- 20 times in 10 seconds

- myelopathy patients much slower

 

Sit

 

Feel

 

Palpate neck

- central / paraspinal / trapezius / posterior triangle

 

Move

 

ROM

- flexion (should be able to get chin to chest)

- extension (should be able to get forehead parallel to ground)

- ear to shoulder

- rotation 80o

 

Tone

- Cogwheel rigidity

- clonus in feet

 

Power

- ASIA (American Spinal Injury Association)

- look for interosseous wasting

- power often especially decreased in hands

 

Reflexes

- increased / inverted BR / Hoffman / Babinski

 

Sensation

- decreased sensation globally / reduced vibration / proprioception

 

Questions

 

What is differential?

- Central / cerebellar cause / Demyelinating disorder

 

How do you differentiate Cerebellar causes?

- Nystagmus / Jaw Jerk

 

What is treatment?

- Depends on Imaging

- No kyphosis, multilevel degeneration - laminoplasty

- Kyphosis / discs / anterior vertebral osteophytes - ACDF / corpectomy and strut grafting