Cervical Myelopathy Presenting without Symptoms in the Upper Extremities: Incidence and Presenting Characteristics.
BACKGROUND:A preponderance of common signs and symptoms of cervical myelopathy (CM) manifest in the upper extremities and include hand numbness, hand clumsiness, and distal upper extremity weakness. Cervical myelopathy presenting without symptoms in the upper extremities is rare and this study aims to better understand the incidence and character of such cases. METHODS:A retrospective review of surgeries for cervical myelopathy from disc herniation, spondylosis, or ossification of the posterior longitudinal ligament (OPLL) over a twelve-year period identifying patients presenting without symptoms in the upper extremities. RESULTS:Of 982 surgically-treated cervical myelopathy patients, 12 (1.2%) had no upper extremity complaints. All had difficulty ambulating and 7 of 12 (58%) had objective lower extremity weakness. Ten of twelve (83%) patients with a history of lumbar degenerative disease. On sensory examination, four (33%) had a discernable mid-thoracic pin level, three (25%) had loss of sensation from the upper leg and genital area down; and two (17%) had only genital/upper thigh area sensory loss. All demonstrated neurological improvement after decompressive surgery. CONCLUSIONS:Cervical myelopathy may rarely present without patient complaints of symptoms in the upper extremities, manifesting with numbness perceived from the upper trunk, waist area, or perineum and legs in addition to leg weakness and gait difficulty All had cervical cord compression at either the C5/6 or C6/7 levels, comprising 1 percent of all patients undergoing cervical surgery. Awareness of this atypical pattern of presentation may aid in clinical assessment of a subset of patients with cervical cord compression.
School of Medicine