Myelopathy

Exam Cram

• Myelopathy is an umbrella term for diseases of the spinal cord

• Presentation: reduced power with LMN signs at the level of the lesion and UMN signs below, sensory changes if sensory columns affected

• Diagnosis: clinical- investigate underlying cause with MRI spine +- MRI Head/ Lumbar Puncture

• Management: identify underlying cause

Outline

Background 

• Myelopathy describes damage to the nerves of the spinal cord- either ascending afferent (sensory) pathways or descending efferent (motor) pathways

• Presentation depends upon the nerves affected- sensory or motor (somatic or autonomic)

Assessment

Presentation:

• Timescale is key for underlying cause

  • Acute onset: vascular- spinal infarct

  • Insidious: space occupying lesion (malignancy, abscess)

  • Relapsing Remitting: MS

  • Trauma

Examination:

• Motor: reduced power

  • UMN signs below lesion- increased reflexes, tone

  • LMN signs at level of lesion- reduced reflexes, tone, muscle wasting & fasciculations

• Sensory involvement

Investigation

• MRI Spine

• Lumbar Puncture

Classification

Aetiology: 

• Commonest: Spinal Disc Prolapse

• Compressive: Disc Prolapse, Spondylarthritis

  • Malignancy- primary or metastasis, Malignant Spinal Cord Compression (MSCC) - emergency

• Infection: Spinal Abscess

• Inflammatory: MS, Transverse Myelitis

• Nutritional: Subacute Degeneration of the Spinal Cord (B12)

• Genetic: Friedreich's Ataxia, Hereditary Spastic Paraplegia

Differential Diagnosis: Myopathy, UMN lesion, LMN lesion

Management

As per underlying cause

• Compression: surgical decompression

• Inflammatory: steroids

• Infectious: antibiotics

• Nutrition: dietician

MDT

• Neurologist, Orthopaedics, Neurosurgeons

• Physio, OT, SW, Dieticians, Psychologist

• Pain team

References and Resources

Page written in 2026.