J Neurol Res

Journal of Neurology Research, ISSN 1923-2845 print, 1923-2853 online, Open Access

Article copyright, the authors; Journal compilation copyright, J Neurol Res and Elmer Press Inc

Journal website http://www.neurores.org

Original Article

Volume 3, Number 5, October 2013, pages 135-141

Level Diagnosis of Cervical Compressive Myelopathy: Signs, Symptoms, and Lesions Levels

Figure 1. Sagittal and axial magnetic resonance imaging (MRI) findings of typical C5-6 and C4-5 intervertebral level myelopathies. (A) T2-weighted MRI of C5-6 intervertebral level myelopathy. Spinal cord corresponding to C5-6 intervertebral level shows a high intensity area (TR, 2400; TE, 120). (B) T2-weighted MRI of C4-5 intervertebral level myelopathy. Spinal cord corresponding to C4-5 intervertebral level is compressed (TR, 2400; TE, 120). (C) T2-weighted axial MRI corresponding to A (C5-6 intervertebral level). Spinal cord shows boomerang shaped deformity (TR, 2400; TE, 120). (D) T2-weighted axial MRI corresponding to B (C4-5 intervertebral level). Spinal cord shows right side dominant deformity (TR, 2400; TE, 120).

Figure 2. Sagittal T2-weighted magnetic resonance imaging of minimal change myelopathy patients (TR, 2400; TE, 120). (A) Patient 1: No apparent compression of the cervical spinal cord. (B) Patient 2: No apparent compression of the cervical spinal cord. (C) Patient 3: No apparent compression of the cervical spinal cord. (D) Patient 4: Narrow canal, but no apparent compression of the cervical spinal cord. (E) Patient 5: No apparent compression of the cervical spinal cord.

**Table 1.** Clinical Characteristics of C4-5 Intervertebral Level Myelopathy
Patient	Age/Sex	Biceps	Brachi	Triceps	PTR	Level	Tingling	Others
Brachi = brachioradialis; PTR = patellar tendon reflex; L/E = lower extremities; U/E = upper extremities; Bil = bilateral; Lt = left; Rt = right; fing. = fingers; Warten. = Wartenberg; hype. = hypesthesia; Inv. = inverted; Atrop. = atrophy; DIO = dorsal interosseous; weak. = weakness.
1	76/F	+++	+++	+++	++/+	-	Right L/E	Wartenberg +
2	66/M	+++	+++	+++	+++	-	-	Marche a petit pas
3	80/M	+	+	++	-/-	C5	-	Romberg +
4	74/F	+	+	+++	+++	C5-6	-	Gait disturbance
5	64/M	++	++	++	+++	-	-	Romberg ±
6	55/F	+++	++	++	+++	-	Left hand	-
7	55/M	++++	++++	+++	++++	C6	-	Sacral sparing, Romberg
8	33/M	±	+++/±	+/++	+++	-	Rt 4 fing.	Finger jerks, Warten. +
9	41/F	+++	+++	+++	+++	C6	Left U/E	Finger jerk, hype. Lt U/E
10	46/M	++	++	Inv.	++	Th3	Bil. thigh	Inverted reflex
11	62/M	±	+	++	++	-	Left hand	Finger jerks
12	76/M	-	-	++	-	-	Feet	Atrop. Lt 1DIO, Lt weak.

Table 1. Clinical Characteristics of C4-5 Intervertebral Level Myelopathy

Patient

Age/Sex

Biceps

Brachi

Triceps

PTR

Level

Tingling

Others

Brachi = brachioradialis; PTR = patellar tendon reflex; L/E = lower extremities; U/E = upper extremities; Bil = bilateral; Lt = left; Rt = right; fing. = fingers; Warten. = Wartenberg; hype. = hypesthesia; Inv. = inverted; Atrop. = atrophy; DIO = dorsal interosseous; weak. = weakness.

76/F

+++

++/+

Right L/E

Wartenberg +

66/M

+++

Marche a petit pas

80/M

-/-

Romberg +

74/F

+++

C5-6

Gait disturbance

64/M

+++

Romberg ±

55/F

+++

Left hand

55/M

++++

+++

++++

Sacral sparing, Romberg

33/M

+++/±

+/++

+++

Rt 4 fing.

Finger jerks, Warten. +

41/F

+++

Left U/E

Finger jerk, hype. Lt U/E

46/M

Inv.

Th3

Bil. thigh

Inverted reflex

62/M

Left hand

Finger jerks

76/M

Feet

Atrop. Lt 1DIO, Lt weak.

**Table 2.** Clinical Characteristics of C5-6 Intervertebral Level Myelopathy
Patient	Age/Sex	Biceps	Brachi	Triceps	PTR	Level	Tingling	Others
Brachi = brachioradialis; PTR = patellar tendon reflex; L/E = lower extremity; U/E = upper extremity; Inv. = inverted; Bil. = bilateral; Marche. = Marche a petit pas; Warten. = Wartenberg; E. = extremities; W. = weakness.
1	78/F	+++	+++	++	++	-	All E.	Hand atrophy
2	50/F	-	±	++	-	-	All (right 3-5)	Romberg +
3	42/M	++/-	+/+++	++	++	-	L/E	Wartenberg -/+
4	66/F	+++	+++	+++	+++	C7	Right U/E	-
5	69/F	+++	+++	Inv.	+++	-	-	Finger jerks, Warten. +
6	69/F	+++	+++	++/±	+++	C7	-	Finger weakness
7	88/M	-	-	+	++	-	-	Gait disturbance
8	54/F	-	-	+/++	-	-	-	Drop object: left hand
9	44/M	++/+++	+/+++	+++	++	C5-6	Bil. forearm	Finger jerks, sacral sparing
10	76/F	+++	+++	++	+	-	-	Gait disturbance
11	79/F	+	+	±	+++	-	-	Marche., Warten. +
12	44/M	+/-	+/-	Inv./++	++	-	Right U&L/E	Inverted right triceps
13	50/M	+++	+++	+++	++	-	-	Finger jerks, ataxic gait
14	47/F	++	++	++	-	-	Both hands	-
15	52/M	+/±	±	++	±/++	-	Left hand	Finger jerks, Warten. +
16	63/F	-	-	++	+++	-	-	Falling tendency
17	30/F	+++	+++	++	++	-	-	Finger jerks, Warten. +, W.
18	37/M	++	++	++	+++	-	Left U&L/E	Wartenberg -/+
19	76/M	++	++	+	++/+++	-	Feet	Vibration disturbance
20	33/M	+++	+++	+++	+++	-	All E.	-
21	73/M	+++/+	++	Inv.	+++	-	Both hands	Inverted triceps reflexes
22	40/M	+++	+++	++	+++	-	Left hand	Finger jerks
23	39/M	±	±	+++	+++	C6	Right U&L/E	-
24	81/M	-	-	++	-	-	-	Neck & shoulder pain

Table 2. Clinical Characteristics of C5-6 Intervertebral Level Myelopathy

Patient

Age/Sex

Biceps

Brachi

Triceps

PTR

Level

Tingling

Others

Brachi = brachioradialis; PTR = patellar tendon reflex; L/E = lower extremity; U/E = upper extremity; Inv. = inverted; Bil. = bilateral; Marche. = Marche a petit pas; Warten. = Wartenberg; E. = extremities; W. = weakness.

78/F

+++

All E.

Hand atrophy

50/F

All (right 3-5)

Romberg +

42/M

++/-

+/+++

L/E

Wartenberg -/+

66/F

+++

Right U/E

69/F

+++

Inv.

+++

Finger jerks, Warten. +

69/F

+++

++/±

+++

Finger weakness

88/M

Gait disturbance

54/F

+/++

Drop object: left hand

44/M

++/+++

+/+++

+++

C5-6

Bil. forearm

Finger jerks, sacral sparing

76/F

+++

Gait disturbance

79/F

+++

Marche., Warten. +

44/M

+/-

Inv./++

Right U&L/E

Inverted right triceps

50/M

+++

Finger jerks, ataxic gait

47/F

Both hands

52/M

+/±

±/++

Left hand

Finger jerks, Warten. +

63/F

+++

Falling tendency

30/F

+++

Finger jerks, Warten. +, W.

37/M

+++

Left U&L/E

Wartenberg -/+

76/M

++/+++

Feet

Vibration disturbance

33/M

+++

All E.

73/M

+++/+

Inv.

+++

Both hands

Inverted triceps reflexes

40/M

+++

Left hand

Finger jerks

39/M

+++

Right U&L/E

81/M

Neck & shoulder pain

**Table 3.** Clinical Characteristics of Minimal Change Myelopathy
Patient	Age/Sex	Biceps	Brachi	Triceps	PTR	Level	Complaint	Others
Brachi = brachioradialis; PTR = patellar tendon reflex; L/E = lower extremities; DIO = dorsal interosseus; Rt = right; f. = fingers; Warten. = Wartenberg; U/E = upper extremities; Vib. = vibration; D. = disturbance.
1	75/M	+++/++	+++/++	++	-	C7	Weakness L/E	Bilateral DIO atrophy
2	36/F	+++/++	+++	+++	+++	C6	Tingling Rt 2, 3 f.	Finger jerks, Warten. +
3	15/F	±	+	++	++	C6-7	Pain of Rt U/E	-
4	57/F	+++	+++	+++	+++	C7	Tingling in both L/E	Finger jerks, Vib. D.
5	68/F	+++	+++/++	+++	++	C5	Blindness of right eye	-

Table 3. Clinical Characteristics of Minimal Change Myelopathy

Patient

Age/Sex

Biceps

Brachi

Triceps

PTR

Level

Complaint

Others

Brachi = brachioradialis; PTR = patellar tendon reflex; L/E = lower extremities; DIO = dorsal interosseus; Rt = right; f. = fingers; Warten. = Wartenberg; U/E = upper extremities; Vib. = vibration; D. = disturbance.

75/M

+++/++

Weakness L/E

Bilateral DIO atrophy

36/F

+++/++

+++

Tingling Rt 2, 3 f.

Finger jerks, Warten. +

15/F

C6-7

Pain of Rt U/E

57/F

+++

Tingling in both L/E

Finger jerks, Vib. D.

68/F

+++

+++/++

+++

Blindness of right eye