Cervico-arthrosic Myelopathy

The cervico-arthrosic Myélopathie is a pathology of the Spinal-cord related to a mechanical compression at the cervical level.

Physiopathology

The Maladie starts in general after 50 years, generally at the men. It is related to the progressive development of anomalies of the cervical rachis in connection with repeated microtraumatisms (repetitive movements of inflection/extension of the neck): Osteophyte S vertebral, projections of the intervertebral discs, thickening Ligament surface.

Diagnosis

The symptoms of the disease evolve/move in general slowly, over several months, as the lesions of the rachis worsen. In rare cases, a brutal aggravation can be observed after a brutal movement or a traumatism of the neck. One finds:

a rachidian syndrome: cervical pains spontaneous or caused by palpation, stiffness, deformations.
an organic syndrome: it is due to the compression of the nervous roots by the deformations of the cervical rachis: pains and Paraesthesia S (tinglings, swarmings) in one or two arms, with disorders of motricity, abolition of one or several Reflex S, amyotrophie (muscular cast iron), cramps, fasciculations muscular. The sensitive disorders are rarer.
an under-organic syndrome: it is due to the suffering of the nervous fibers which walk on in marrow, by compression.

driving Anomalies: pyramidal limping, disorders of the motricity of the lower extremities, Sign of Babinski bilateral, hyperrefléxie ostéo-tendineuse.
sensitive Anomalies: variables according to the topography of the attack. In general, compression is posterior and thus gives a posterior syndrome cordonnal with disorders of the major sensitivity. These anomalies are in general bilateral, unbounded higher clear.
Turbid sphinctériens: in general discrete and late (one can observe pressing micturitions, a dysurie).

Complementary examinations

The best examination exploring marrow is the medullary IRM, which must be realized in first intention in the event of manifest compression. The other examinations are:

Radiography S of the rachis of face, profile, 3/4 right and left which will be able to find the osteophytes, of the indirect signs of compression.
medullary Scanner, with and without injection of Iodine.
the lumbar Ponction with analysis of the céphalo-rachidian Liquide is useless (generally normal)
the Myélographie is not almost more carried out, it can be useful if the IRM is impossible.

Treatment

There exist two possibilities of assumption of responsibility, according to the impact of the disease on the patient, whom it is advisable to evaluate well. In all the cases, it is necessary to keep in mind that the rachidian anomalies are very frequent after 50 years and that morphological anomalies detected by the imagery without any functional sign should not justify a treatment.

moderated Symptomatology, little invalidating: medical care and physical .

Put at rest of the cervical rachis: port of a cervical Minerve, Sick leave in the event of painful tasks,
Kinesitherapy: soft cervical tractions,
Antalgic and anti-inflammatory drugs not stéroïdiens in the event of pains,
the infiltrations of Glucocorticoïde S can be discussed with the patient,
Surveillance of the evolution of the disease, education of the patient for the prevention of the factors of aggravation.

Symptomatology severe and invalidating, patient justified by the surgery and without operational counter-indications: surgical Treatment

Laminectomie extended in the event of diffuse attack several rachidian stages,
Surgery by former way with reduction of the osteophytes, discectomy, Arthrodèse when the attack is limited to one or two cervical Vertèbre S.

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