As we age, the spine may develop degenerative changes in the joints that can create tightening of the spinal canal. Over time this process may lead to pinching the spinal cord and compromise of coordination of the extremities. Myelopathy affects the nerve tracts that run inside the spinal cord (long tracts) and deficits in these long tracts can be picked up on physical exam. For example:
Muscular tone in the legs will be increased.
Deep tendon reflexes in the knee and ankle will be accentuated (hyperreflexia)
Forced extension of the ankle may cause the foot to beat up and down rapidly (clonus)
Scratching the sole of the foot may cause the big toe to go up (Babinski reflex) instead of down (normal reflex)
Flicking the middle finger may cause the thumb and index finger to flex (Hoffman’s reflex)
Compromised coordination may be evidenced by difficulty walking placing one foot infront of the other (tandem walking)
People with this condition may note one or more of the following symptoms:
• Heavy feeling in the legs
• Inability to walk at a brisk pace
• Deterioration in fine motor skills (such as handwriting or buttoning a shirt)
• Intermittent shooting pains into the arms and legs (like an electrical shock), especially
when bending their head forward (known as Lermitte’s phenomenon)
• Arm pain ( radiculopathy)
Often it is the arm pain that prompts someone with this condition to seek medical treatment, and then the myelopathy is discovered through medical history and physical exam.
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