Cervical myelopathy is often due to degenerative narrowing of the spinal canal with resulting spinal cord compression. Patients with inflammatory diseases of the spine, such as rheumatoid arthritis, are at elevated risk. The initial presentation is often with (poly-)radicu-lar deficits due to narrowing of the intervertebral foramina; as the spinal canal itselfbecomes increasingly stenotic, clinically evident spinal cord compression develops. Patients typically complain at first of paresthesiae in the fingers and impairment of the sense of touch (examination reveals astereognosis). The intrinsic muscles of the hands may become atrophic. Ultimately—or, rarely, as the sole manifestation—involvement of the long white matter tracts produces spastic paraparesis, enhanced reflexes, and pyramidal tract signs. Neuroimaging is essential for the establishment of the diagnosis; MRI is best (Fig. 7.8). Neurosurgical decompression of the spinal canal, possibly with spinal stabilization (fusion) at the same procedure, generally arrests the progression of the neurological deficits.
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