Conditions of the Back and Neck Quiz

See Cervical myelopathy. Option E is correct. Myelopathy means a disorder of the spinal cord itself, and in cervical myelopathy the cord is compressed because the spinal canal in the neck is narrowed. Causes include spondylosis (degenerative wear), spondylolisthesis (a slipped vertebra), a congenitally narrow canal, trauma or a tumour. The classic picture is a loss of balance, poor coordination, reduced hand dexterity (for example difficulty with buttons or writing) and limb weakness or numbness. The cord carries the long motor and sensory pathways to and from the whole body, so compression produces upper motor neurone signs (stiffness, brisk reflexes) below the level of the lesion. Another clue is Lhermitte's phenomenon, intermittent electric-shock sensations in the limbs made worse by bending the neck forwards. The diagnosis is made by a thorough neurological examination and an MRI scan. Because the usual cause is degenerative, it tends to progress, so treatment is usually surgical.

• Definition: compression of the spinal cord because the spinal canal in the neck is narrowed.
• Features: loss of balance, poor coordination, reduced hand dexterity and limb weakness or numbness.
• Clue: Lhermitte's phenomenon, electric-shock sensations in the limbs on bending the neck forwards.
• Management: diagnosis by examination and MRI, and treatment is usually surgical.