Which pattern most strongly suggests cervical myelopathy rather than radiculopathy?

Which pattern most strongly suggests cervical myelopathy rather than radiculopathy?

• A. Ataxic gait and wide-based stance
• B. Pain with neck movement and dermatomal distribution
• C. Focal numbness in hand only
• D. Weakness limited to one myotome

Answer: (B)

The key idea is telling apart spinal cord problems from nerve root problems. Cervical myelopathy comes from compression of the spinal cord itself, so it tends to affect multiple pathways and produce signs that reflect upper motor neuron involvement and proprioceptive loss. A gait that’s unsteady or wide-based often signals dorsal column dysfunction and corticospinal tract involvement from cord compression, i.e., myelopathy. You may see a spastic, uncoordinated walk and other UMN signs as the cord is encumbered. Radiculopathy, on the other hand, is rooted in a single nerve root. It typically presents with pain and sensory changes that map to a specific dermatome and weakness in a specific myotome, without the broad, multi-system gait and UMN signs seen with myelopathy. So, a pattern like ataxic or wide-based gait due to cord involvement strongly suggests cervical myelopathy. Pain with neck movement and dermatomal distribution fits radiculopathy because it reflects root-level irritation rather than cord-level multi-tract involvement.

The key idea is telling apart spinal cord problems from nerve root problems. Cervical myelopathy comes from compression of the spinal cord itself, so it tends to affect multiple pathways and produce signs that reflect upper motor neuron involvement and proprioceptive loss. A gait that’s unsteady or wide-based often signals dorsal column dysfunction and corticospinal tract involvement from cord compression, i.e., myelopathy. You may see a spastic, uncoordinated walk and other UMN signs as the cord is encumbered.

Radiculopathy, on the other hand, is rooted in a single nerve root. It typically presents with pain and sensory changes that map to a specific dermatome and weakness in a specific myotome, without the broad, multi-system gait and UMN signs seen with myelopathy.

So, a pattern like ataxic or wide-based gait due to cord involvement strongly suggests cervical myelopathy. Pain with neck movement and dermatomal distribution fits radiculopathy because it reflects root-level irritation rather than cord-level multi-tract involvement.