Article Review 15

Authors’ names

Kim HJ, Tetreault LA, Massicotte EM, Arnold PM, Skelly AC, Brodt ED, Riew KD.

Article name

Differential diagnosis for cervical spondylotic myelopathy: literature review

Journal Name

US National Library of Medicine National Institutes of Health

Bibliography

Kim, H J, et al. “Differential Diagnosis for Cervical Spondylotic Myelopathy: Literature Review.” Current Neurology and Neuroscience Reports., U.S. National Library of Medicine, 15 Oct. 2013, www.ncbi.nlm.nih.gov/pubmed/23962997. doi: 10.1097/BRS.0b013e3182a7eb06.

Purpose of the article

The purpose of this article is purpose to identify case series that have been confused with cervical spondylotic myelopathy (CSM) to develop a comprehensive differential diagnosis.

Brief Description of Procedure and Findings/Results

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.

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.

Conclusions and Comments

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. Physical exam findings are not always consistent with the 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.

The opinion of the article

In my opinion, this article proved that magnetic resonance imaging is useful to detect cervical myelopathy but correlation to other modalities might be needed to make the diagnosis more accurate.