Severe Cord Compression C5-6

Transverse myelopathy mimicking conus medullaris syndrome

■ The first priority in the evaluation of a patient with an acute transverse myelopathy is to obtain an MRI of the entire spinal cord, with and without contrast, to search for a cord-compressive etiology that may be amenable to prompt neurosurgical decompression to prevent cord infarction.


■ Once cord-compressive etiologies are excluded, the next priority is to evaluate findings from MRIs and CSF analysis that will further categorize the myelopathy as inflammatory or noninflammatory. 


■ Once criteria for spinal cord inflammation are met, the next priority is to test for etiologies known to induce CNS inflammation.


■ When initial laboratory testing does not reveal a specific diagnosis, further evaluation is based on the extent of demyelination seen on MRI and whether the pattern of myelitis is consistent with a partial versus a longitudinally extensive myelitis.


A previously healthy 53-year-old man presented to his primary care physician's office after awaking that morning with numbness below the waist. The numbness involved the perineal area, genitals, buttocks, posterior aspect of the right leg, and plantar aspect of both feet. The patient reported erectile dysfunction (ED), along with difficulties eliminating urine and stool as a result of pelvic floor and sphincter paralysis; he denied incontinence. The patient also noted a mild gait imbalance resulting from foot numbness and mild weakness of his right hip but denied any back or leg pain. He recalled several episodes of transient genital numbness a few months earlier. Prior to the current problem, he had been in his usual state of good health, except for an upper respiratory tract infection 3 weeks before this encounter. 


History Past neurologic history was significant for migraine headaches with aura beginning at age 30 years. Three years ago, while on vacation in New Zealand, he developed diplopia that was attributed to a left cranial nerve palsy that gradually resolved over an 8-week period. MRI of the brain (with and without contrast) was read by a neurologist as normal, and the palsy was presumed to be microvascular in etiology. The patient also reported a history of chronic gastroesophageal reflux disease (GERD), hereditary hemochromatosis, and childhood asthma. Current therapies included esomeprazole and famotidine for the GERD and periodic maintenance phlebotomies for hemochromatosis. Family history was negative for neurologic disorders, diabetes mellitus, multisystemic autoimmune or vasculitic diseases, and coagulopathies.

Leading cause of cervical spinal stenosis | Bone disease

The development of cervical factors, the cervical spinal canal stenosis than normal pits. Cervical cord cross-section, on both sides of the central part of thick and thin, the central front in the adult spinal cord diameter is 8-10MM, such as the anteroposterior diameter of the spinal canal is too narrow, can direct spinal cord compression, nerve root and dura mater, the dominant part of the soft tissue of the sympathetic nerve fibers are also likely to be compression of vasospasm. Developmental cervical spinal canal stenosis is caused by spinal cord cervical spondylosis of the main factors. Patients at a young age, although there is cervical spinal stenosis developmental phenomenon, but because of compensatory function, usually no obvious symptoms; adult, because the cervical vertebrae degeneration occurs, often by the head and neck trauma or strain, so that can gradually be some spinal cord symptoms, cervical spine X-ray examination, most patients good cervical alignment, no obvious posterior margin of vertebral bone growth or shift, mainly around the spinal canal stenosis, cervical spinal stenosis in the lower part The more severe.

Asymptomatic adults, the anteroposterior diameter of cervical spinal canal 2-7 in the 14.5MM these are developmental spinal stenosis.

(2) spinal stenosis hyperostosis

Patient age was 40 years old, due to cervical disc degeneration, vertebral bone hyperplasia, causing various degrees of spinal canal stenosis was before. Is a common clinical nerve root, vertebral artery syndrome or the incidence of cervical spinal cord causes cervical spinal stenosis in 4 – 6 cervical spine, some patients in the cervical spine 3 or 7. Spinal stenosis can also be due to spinal cord compression symptoms

Many adults or elderly clinically, although the marked hyperplasia of vertebral bone. But because of its larger anteroposterior diameter of the spinal canal, without any symptoms.

(3) the instability of the spinal stenosis

Cervical spine instability, mostly middle-aged patients, due to cervical disc, ligament and joint capsule and other tissues caused by degeneration or injury; younger patients because of neck trauma can be Erzhi cervical subluxation ; small number of patients after surgery for cervical spondylosis adjacent cervical compensatory activity increases due to instability, cervical flexion injury patients, the transverse ligament of atlas, the first song when the forward displacement of the atlas. Spacing of atlantoodontoid 3-10MM, extension activities, cervical spine instability after the shift can be 1-4MM, moved back under the trailing edge of cervical vertebral arch of the upper edge of the next form of cervical spinal stenosis area, heavier symptoms , activities are often limited to the back of the neck, posterior neck muscle hypertonia or muscle spasm, some patients for neck extension activities, the limbs and trunk are numbness, leg muscle twitching can occur. This is because the phenomenon of cervical cord pathology of oppression.

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