# Cervical Spondylotic Myelopathy

> Cervical spondylotic myelopathy for NEET-SS Neurosurgery: gait and hand symptoms, UMN signs, mJOA and Nurick scores, Torg ratio and surgical choices.

- Canonical URL: https://prepelephant.com/topics/neet-ss/neurosurgery/cervical-myelopathy
- Exam / course: NEET-SS · Subject: Neurosurgery
- Publisher: PrepElephant (https://prepelephant.com) — Prepared and reviewed by the PrepElephant Academic Review Team
- First published: 2026-10-02
- Last updated: 2026-10-02
- How to cite: "Cervical Spondylotic Myelopathy", PrepElephant, https://prepelephant.com/topics/neet-ss/neurosurgery/cervical-myelopathy

## Direct answer

Cervical spondylotic myelopathy is compression of the cervical cord by degenerative discs, osteophytes, infolded ligamentum flavum and sometimes ossified posterior longitudinal ligament, and it is the commonest cause of spinal cord dysfunction in older adults. The signature is gait disturbance with spasticity plus clumsy hands: upper motor neuron signs in the legs with or without lower motor neuron signs at the compressed levels. Severity is graded by the modified Japanese Orthopaedic Association (mJOA) score, and moderate-to-severe or progressive disease is treated surgically by anterior or posterior decompression according to the level, number of segments, alignment and sagittal balance.

## What you must remember

- Symptom sequence: gait abnormality is typically the earliest and most reliable symptom — spastic, unsteady, broad-based; hand clumsiness with fine-motor loss (buttons, writing) follows, with sensory symptoms often vague.
- Examination: hyperreflexia, clonus, extensor plantar responses, Hoffmann sign, spastic paraparesis, and a sensory level is often absent; radicular Lhermitte phenomena may occur with neck flexion.
- Scoring: mJOA is an 18-point functional scale (gait, upper and lower limb function, sphincter); common severity bands are mild 15-17, moderate 12-14 and severe 11 or below, and Nurick grades 0-5 focus on gait.
- Imaging: MRI demonstrates cord compression and T2 cord signal change (a marker of poorer recovery); a Torg-Pavlov ratio below about 0.8 on lateral radiographs suggests a developmentally narrow canal; OPLL is best seen on CT.
- Surgical options: anterior cervical discectomy and fusion or corpectomy for one-to-two-level anterior disease; laminoplasty or laminectomy with fusion for multilevel compression with preserved lordosis; kyphosis or anterior compression across few levels pushes toward anterior surgery.
- Mild, non-progressive disease may be managed conservatively with observation and activity modification, but the natural history is stepwise deterioration, and function lost long before surgery returns incompletely.
- Differentials with similar beds: amyotrophic lateral sclerosis (no sensory findings, both UMN and LMN without a level), B12 subacute combined degeneration (dorsal column loss with peripheral neuropathy), and multiple sclerosis.

## Common confusion

Myelopathy is confused with radiculopathy: radiculopathy is dermatomal pain with LMN weakness and reflex loss at one level, while myelopathy is tract-based with UMN signs below. Combined myeloradiculopathy is common and explains a wasted biceps with brisk knees in one patient. The surgical route question is frequently answered by habit rather than principle — number of involved segments, site of compression and sagittal alignment, not surgeon preference alone, should drive anterior versus posterior.

## Exam-focused takeaway

The classic stem is an older adult with progressively unsteady gait, clumsy hands, brisk reflexes and extensor plantars plus neck crepitus — MRI confirms multilevel compression, and mJOA grading follows. Expect one mark each for Hoffmann sign, the Torg ratio, and choosing anterior versus posterior surgery by segments and alignment. A "which of the following is not expected" variant usually offers a dermatomal pain pattern or a sensory level as the intruder, and the differential from motor neuron disease is a recurring viva crossover.

## Frequently asked questions

### What is the earliest symptom of cervical spondylotic myelopathy?

Gait disturbance — spastic, unsteady walking — typically precedes hand clumsiness and sensory complaints.

### What does the mJOA score measure?

An 18-point scale of gait, upper and lower limb function and bladder function; lower scores indicate more severe myelopathy and support operative treatment.

### What does T2 hyperintensity within the cord signify?

Chronic compression with myelomalacia or oedema; it correlates with incomplete recovery after decompression.

### How is the surgical approach selected?

By number of levels, site of compression and sagittal alignment: anterior for one or two level anterior compression, posterior laminoplasty or laminectomy-fusion for multilevel lordotic compression, anterior or combined when kyphotic.

### How is myelopathy distinguished from motor neuron disease?

Myelopathy has sensory findings and a compressive level on imaging; amyotrophic lateral sclerosis mixes UMN and LMN signs without sensory change or a tract level.