Differential Diagnosis for Cervical Spondylotic Myelopathy: Literature Review

Kim, Han Jo MD*; Tetreault, Lindsay A. HBSc; Massicotte, Eric M. MD, MSc, FRCSC; Arnold, Paul M. MD§; Skelly, Andrea C. PhD, MPH; Brodt, Erika D. BS; Riew, K. Daniel MD

doi: 10.1097/BRS.0b013e3182a7eb06
Diagnosis, Work-Up, and Treatment Planning

Study Design. Literature review.

Objective. To identify case series that have been confused with cervical spondylotic myelopathy (CSM) to develop a comprehensive differential diagnosis.

Summary of Background Data. Myelopathy can be caused by a number of different etiologies. In those patients with CSM, the presentation is not always clear. Distinct radiographical and clinical characteristics, which are not always obvious, aid in arriving at the correct diagnosis.

Methods. A PubMed search was done to identify reports written in English describing conditions that may present in a manner similar to CSM to differentiate them from CSM. Material from review articles and relevant textbooks was also considered. Information regarding the number of patients, the specific diagnosis presenting as myelopathy, the diagnostic findings, and the method(s) for distinguishing CSM from the initial diagnosis was abstracted from included articles. Salient features of the conditions were summarized.

Results. A total of 35 citations (totaling 474 patients) that reported on diagnoses confused with CSM based on clinical presentation were included. All were case reports or small case series. The differential diagnoses were organized into 7 categories: congenital/anatomic, degenerative, neoplastic, inflammatory/autoimmune, idiopathic, circulatory, and metabolic. The primary conditions in the differential included amyotrophic lateral sclerosis, multiple sclerosis, syringomyelia, and spinal tumors.

Conclusion. In the vast majority of cases, magnetic resonance imaging was an invaluable tool in determining the correct diagnosis. Electrodiagnostic studies, cerebrospinal fluid profile, unique symptomatology, and consideration of patient demographics can also aid in the diagnosis. Bilateral sensory complaints in the hands are suspicious for cervical cord pathology and MR imaging of the same should be done even if the electromyography/nerve conduction studies (NCS) suggest bilateral carpal tunnel syndrome.

Summary Statements. Physical exam findings are not always consistent with severity of disease in CSM; therefore, correlation to plain radiographs, MRI, and patient symptomatology is essential for arriving at the correct diagnosis. In some cases where these studies are still equivocal, use of other studies should be considered including electrodiagnostic studies as well as cerebrospinal fluid examination.

Physical examination findings are not always consistent with severity of disease in cervical spondylotic myelopathy; therefore, correlation with plain radiographs, magnetic resonance images, and patient symptomatology is essential for arriving at the correct diagnosis. In some cases where these studies are still equivocal, other studies, including electrodiagnostic studies, should be considered.

*Spine and Scoliosis Service, Hospital for Special Surgery, New York, NY

Institute of Medical Sciences University of Toronto, Toronto Western Hospital, Toronto, Ontario, Canada

Department of Surgery, University of Toronto, Toronto, Ontario, Canada

§University of Kansas Hospital, Kansas City, KS

Spectrum Research, Inc., Tacoma, WA; and

Department of Cervical Spine Surgery, Washington University Orthopedics, Washington University School of Medicine, St. Louis, MO.

Address correspondence and reprint requests to Han Jo Kim, MD, Spine and Scoliosis Service, Hospital for Special Surgery, 525 East 70th St, New York, NY 10021; E-mail: hanjokimmd@gmail.com

Acknowledgment date: March 5, 2013. First revision date: June 3, 2013. Second revision date: July 18, 2013. Acceptance date: July 30, 2013.

The manuscript submitted does not contain information about medical device(s)/drug(s).

Supported by AOSpine North America, Inc. Analytic support for this work was provided by Spectrum Research, Inc., with funding from the AOSpine North America.

Relevant financial activities outside the submitted work: board membership, consultancy, payment for writing or reviewing the manuscript, support for travel, fees for participation in review activities, expert testimony, grants/grants pending, royalties, stock/stock options, and travel/accommodations/meeting expenses.

© 2013 by Lippincott Williams & Wilkins