CERVICAL

MYELOPATHY

REZKI ARGHA NAULI

C 111 10 290

Advisor:
dr. FAHRONI CAHYONO WINATA
dr. ALFA JANUAR KRISTA

Supervisor:
dr. Karya Triko Subiakto, Sp.OT(K)Spine

IDENTITY
Name

: Mr. A.B.

Age

: 65 years old / Male

Admission : February 9th, 2015

Registratio : 70 05 97
n
Status

: JKN

AUTOANAMNESIS
Chief Complain : Cannot move both of lower
extremity

Suffered since 21 days before admitted to Wahidin

General Hospital
24 days ago, patient suddenly felt weakness of his
lower extremities, but could still walk with
assistance. Patient went to Daya Hospital and had
been given physiotherapy but no improvement.
21 days ago, patient couldnt walk anymore and
couldnt move both of leg. Patient admitted to
Daya Hospital for 10 days and after that referred
to Ibnu Sina Hospital and underwent MRI cervical
examination.

Patient also complained pain at his neck since 5

weeks ago, dullness pain, intermittent, not

referred, duration 5 10 minutes, worsen when
activity and better when rest, worse at night (-)
Patient could not sense defecation and urination.
History of fever 4 weeks ago for 3 days
History of chronic cough (-), history of weight
loss (-), history of tumour (-) , history of family
member with tumour (-)
history of hypertension (+), diabetes mellitus (-)

GENERAL STATUS
Conscious / Well-nourished
Vital Signs:

Blood pressure
: 150/100 mmHg
Pulse rate
: 90 x/min
Respiratory rate
: 20 x/min
Temperature
: 37 0C

LOCAL STATUS
Vertebra Region
Look : Decubitus Ulcer Grade I at parasacralis
dextra, multiple, 4 x 3 cm, Deformity (-),
swelling (-), hematoma (-)
Feel
: Tenderness (+) at vertebrae cervical,
Step Off (-)

4
3
3
1
1

0
0
0
0
0
0

0
NT
0
0
0
NT
0
NT
0

3
3
1
1

No

2
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2
2
2
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2
2
2
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2
2
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2
2
2

2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2

2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2

2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2

Any anal sensation

N

0 Absent
1 Impaired
2 Normal
NT Not testable

REFLEX
Physiologic
Reflex

Biceps

R
L
(N) (N)

Triceps
Achilles
Patellar

(N) (N)
(-) (-)
(-) (-)

Pathologic Reflex

Hoffman
Trommer
Chadock
Openheim
Babinski

R
L
(+) (+)
(+) (+)
(+) (+)
(+) (+)

RECTAL TOUCHER
Sphincter tone was loose
Mucous was smooth
Ampula recti is filled with faeces
Prostat gland is difficult to evaluate due to

faeces
Gloves : blood (-), slime (-), feces (+)
Bulbocavernosus reflex (+)

CLINICAL FINDINGS

RADIOLOGY FINDINGS
(Cervical AP/Lateral)

Thorax

Pelvic

MRI

LABORATORY FINDINGS
WBC
RBC
HGB
HCT
PLT
CT
BT

:
:
:
:
:

11.200 /ul
3.590.000/ul
11,1 g/dl
34 %
189.000/ul
: 700
: 300

Albumin : 2,7 g/dL

SGOT : 31 U/dL
SGPT: 29 U/dL
Ureum : 20 mg/dL
Creatinine : 0,90

mg/dL
RBG : 113 g/dL
HBsAg : Non-reactive

DIAGNOSIS
Servical Myelopathy
Decubital ulcer grade I
Hipoalbuminemia

MANAGEMENT
IVFD RL
Antibiotic
Plan for surgery : Corpectomy

DISCUSSION

THE SPINE
33 Vertebrae:

7 Cervical (lordosis)

12 Thoracic (kyphosis)

5 Lumbar (lordosis)

5 Sacral fused (kyphosis)

4 Coccygeal (fused)

Source: Netters Concise Orthopaedic Anatomy, 2nd ed.

THE SPINE
Root exit spinal column via
intervertebral foramen
C1-7 : exit above their
vertebra

C8-L5 : exit below their

vertebra (C7 exit above C7
vertebra and C8 exit below C7
vertebra)

Medula spinalis end at L1

(Conus Medullaris)

Lumbar and sacral nerve form

cauda equina in spinal canal
Source:
Netters Concise
before
exit Orthopaedic Anatomy, 2nd ed.

What is cervical myelopathy?

Myelopathy is the manifestation that
caused
by
cervical
spinal
cord
compression.

Vincent J D. Evaluation of cervical spine disorder, Spine Secret Plus, 2nd Edition 2012

PATOGENESIS
Trauma resulting vertebra spinal cord

compression
The process of inflammation , for example
myelitis
urgent spinal cord tumors
Vascular diseases , such as vascular
myelopathy
Congenital due to spinal canal stenosis
Degenerative diseases , such as spondylosis
or herniated intervertebral discs resulting in

PATOLOGICAL PROCESS
The underlying cause of the condition is

compression of the long tracts in the spinal

cord.
The normal diameter of the cervical spinal
canal is between 17 mm and 18 mm. When
this diameter falls below 12 mm to 14 mm for
any reason this is likely to cause stenosis and
myelopathic symptoms.
The average diameter of the spinal cord in the
cervical spine is 10 mm.

The common pathological processes underlying

cervical myelopathy are outlined below:

Disc Herniation
Congenital
Spondylosis
Post traumatic myelopathy
Ossification of the posterior longitudinal

ligament (OPLL)
Myelopathy due to tumour expansion

DIAGNOS
IS
HISTORY TAKING

HISTORY
HISTORY
TAKING
TAKING
10-20% 1st
notice leg
symptoms.
1/3
notice
electric shock
sensations
on extending
neck
indicating an
early
stage to
disease.
Sholahuddin R. Cervical myelopathy Orthopeadi Spine UI

PHYSICAL
PHYSICAL
EXAMINATIONS
EXAMINATIONS

NEUROLOGIC
EVALUATION

Jon C. Thompson Spine Netter's Concise Orthopaedic Anatomy, 2010

PHYSICAL
PHYSICAL
EXAMINATIONS
EXAMINATIONS
NEUROLOGIC EVALUATION

Jon C. Thompson Spine Netter's Concise Orthopaedic Anatomy, 2010

PHYSICAL
PHYSICAL
EXAMINATIONS
EXAMINATIONS

Jon C. Thompson Spine Netter's Concise Orthopaedic Anatomy, 2010

PHYSICAL
PHYSICAL
EXAMINATIONS
EXAMINATIONS
SPECIAL TEST
UPPER EXTREMITIES

LOWER EXTREMITIES

Hoffmanns sign
Finger escape sign (finger

adduction test)
Grip-and-release test
Inverted radial reflex
Scapulohumeral reflex

Babinskis test
Clonus
Lhermittes sign

Vincent J D. Evaluation of cervical spine disorder, Spine Secret Plus, 2nd Edition 2012

THANK YOU