Cervical spinal stenosis clinical features [Neurosurgery Wiki]

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====== Cervical spinal stenosis clinical features ======

[[Cervical spinal stenosis]] can change how the [[spinal cord]] functions and cause [[pain]], [[stiffness]], [[numbness]], or [[weakness]] in the [[neck]], [[arm]]s, and [[leg]]s. It can also affect the control of [[bowel]]s and [[bladder]].

Many people older than age 50 have some narrowing of the spinal canal but do not have symptoms. Cervical spinal stenosis does not cause symptoms unless the spinal cord or nerves becomes squeezed. Symptoms usually develop gradually over a long period of time.
   
Balance and coordination problems, such as shuffling or tripping while walking. Cervical spinal stenosis can be crippling if the spinal cord is damaged.
    
Loss of bowel or bladder control (incontinence).

[[detrusor hyperactivity]] or underactivity may occur depending on whether the involvement of the micturition neural axis
is compression of the inhibitory [[reticulospinal tract]]s or [[myelopathy]] involving the [[posterior funiculus]]
----
Patients with [[degenerative cervical myelopathy]] may initially experience minimal [[symptom]]s
((Kovalova I, Kerkovsky M, Kadanka Z, Kadanka Z Jr, Nemec M, Jurova B, Dusek L, 
Jarkovsky J, Bednarik J. Prevalence and Imaging Characteristics of Nonmyelopathic
and Myelopathic Spondylotic Cervical Cord Compression. Spine (Phila Pa 1976).
2016 Dec 15;41(24):1908-1916. PubMed PMID: 27509189.
))
((Martin AR, De Leener B, Cohen-Adad J, Cadotte DW, Nouri A, Wilson JR,
Tetreault L, Crawley AP, Mikulis DJ, Ginsberg H, Fehlings MG. Can microstructural
MRI detect subclinical tissue injury in subjects with asymptomatic cervical
spinal cord compression? A prospective cohort study. BMJ Open. 2018 Apr
13;8(4):e019809. doi: 10.1136/bmjopen-2017-019809. PubMed PMID: 29654015; PubMed 
Central PMCID: PMC5905727.
))
but subsequently often develop [[pain]], [[sensory deficit]]s especially affecting their [[hand]]s and [[foot]], [[spasticity]], [[imbalance]], [[bladder]] symptoms, and experience frequent [[fall]]s
((Davies BM, Mowforth OD, Smith EK, Kotter MR. Degenerative cervical myelopathy.
BMJ. 2018 Feb 22;360:k186. doi: 10.1136/bmj.k186. Review. PubMed PMID: 29472200; 
PubMed Central PMCID: PMC6074604.
)).

Diagnosing DCSM has traditionally relied on presence of clinical symptoms, including [[clumsy hands]], paralysis of the lower extremities, [[gait disturbance]]s, urinary/[[bowel incontinence]] and severe neurological dysfunction disturbances.
((Guan L, Chen X, Hai Y, et al. High-resolution diffusion tensor imaging in cervical spondylotic myelopathy: A preliminary follow-up study. NMR Biomed. 2017))
((Sampath P, Bendebba M, Davis JD, et al. Outcome of patients treated for cervical myelopathy. A prospective, multicenter study with independent clinical review. Spine (Phila Pa 1976) 2000;25(6):670–76.)).

Many people with [[cervical spondylosis]] or CSM are asymptomatic. However, patients with CSM are at higher risk of [[spinal cord injury]] (SCI) following minor injury.

Only a small percentage of people with spondylosis go on to develop [[symptom]]s consistent with [[cervical spondylotic myelopathy]] (CSM), which can cause significant and disabling [[neurological deficit]]s, leading to loss of function, [[morbidity]], and [[mortality]].

In addition, [[diabetes mellitus]] (DM) is a frequent [[comorbidity]] for people of this age and may impact the severity of CCM. 

===== Pain =====

Pain is commonly identifiable in large areas of the body, is frequently moderate to severe in intensity and impacts [[quality of life]] and severity of [[myelopathy]] in a cohort of individuals with myelopathy who have pain
((Boerger T, Alsouhibani A, Mowforth O, Hamilton J, Lalkhen A, Davies BM, Kotter MRN. Moving Beyond the Neck and Arm: The Pain Experience of People With Degenerative Cervical Myelopathy Who Have Pain. Global Spine J. 2021 Feb 25:2192568220986143. doi: 10.1177/2192568220986143. Epub ahead of print. PMID: 33626937.)).

===== Gait disturbances =====
There is evidence that people with CSM have a slower gait speed, prolonged double support duration and reduced cadence compared to healthy controls 
((Kuhtz-Buschbeck JP, Johnk K, Muder S, Stolze H, Mehdorn M. Analysis of gait in cervical myelopathy. Gait Posture. 1999;9(3):184–189. doi: 10.1016/S0966-6362(99)00015-6.))
((Singh A, Crockard HA. Quantitative assessment of cervical spondylotic myelopathy by a simple walking test. Lancet. 1999;354(9176):370–373. doi: 10.1016/S0140-6736(98)10199-X.))
((Singh A, Choi D, Crockard A. Use of walking data in assessing operative results for cervical spondylotic myelopathy: long-term follow-up and comparison with controls. Spine (Phila Pa 1976) 2009;34(12):1296–1300. doi: 10.1097/BRS.0b013e3181a09796.))
((Maezawa Y, Uchida K, Baba H. Gait analysis of spastic walking in patients with cervical compressive myelopathy. J Orthop Sci Off J Jpn Orthop Assoc. 2001;6(5):378–384.)).

At self-selected speed, the CSM group walked significantly more slowly, with shorter stride lengths and longer double support duration. They showed significant decreases in several kinematic and kinetic parameters, including sagittal range of motion at the hip and knee, ankle plantarflexion, anteroposterior ground reaction force (GRF) at toe-off, power absorption at the knee in loading response and terminal stance, and power generation at the ankle. At matched speed, the CSM group showed significant decreases in knee flexion during swing, total sagittal knee range of motion, peak ankle plantarflexion and anteroposterior GRF.

Conclusion and implications: The findings suggested that people with CSM have significant gait abnormalities that have not been previously reported. In particular, there are key differences in the motor strategies used in the terminal stance phase of gait that cannot be explained by speed alone
((Malone A, Meldrum D, Bolger C. Gait impairment in cervical spondylotic myelopathy: comparison with age- and gender-matched healthy controls. Eur Spine J. 2012 Dec;21(12):2456-66. doi: 10.1007/s00586-012-2433-6. Epub 2012 Jul 24. PMID: 22825630; PMCID: PMC3508234.))