Cervical Radiculopathy vs. Myelopathy

Can you answer these questions?  (Answers in post!)

1. Is radiculopathy an upper motor neuron OR lower motor neuron problem?
2. What is the plan of care for someone with cervical myelopathy (treat, refer out, both)?
3. What are the 4 clinical criteria for a diagnosis of cervical radiculopathy?

Key Information to Know

Chronic cervical degeneration is the most common cause of progressive spinal cord and nerve root compression. These spondylotic (arthritic) changes can result in stenosis of the spinal canal, lateral recess, and/or foramina. Stenosis is defined as ANY narrowing of a canal leading to nerve compression. When stenosis occurs centrally, compressing the spinal cord, it is called myelopathy. When stenosis occurs laterally, compressing the nerve roots, it is called radiculopathy.

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Cervical Myelopathy

Central spinal stenosis is known as myelopathy. An individual with myelopathy will present with Upper Motor Neuron signs and symptoms. These symptoms include gait ataxia, a positive Babinski test, a positive Inverted Supinator sign, a positive Hoffman's test, hyperreflexia, potential bowel and bladder changes, among other findings. Since the spinal cord is compressed, a referral for imaging is recommended to assess the amount of compression. Assuming the patient does not have severe compression with hard neurological findings, the patient will likely be appropriate to continue resume their Physical Therapy plan of care. ​

Cervical Radiculopathy

Cervical radiculopathy has many different symptoms than myelopathy. In radiculopathy, the nerve root (not the spinal cord) is the involved structure. When the nerve root is placed under compression or tension (or any additional stress), individuals will typically have a myotomal pattern of weakness, a dermatomal pattern of sensory loss, hyporeflexia, positive Spurlings Maneuver, positive Distraction Test, decreased cervical rotation to the involved side, and a positive median nerve tension test. 

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Cervical Radiculopathy Case Study

See how Dr. Chris Fox PT, DPT, OCS treats Cervical Radiculopathy

For more information on treating cervical radiculopathy and myelopathy, please check out our new course on the ​Orthopedic Management of the Cervical Spine! In this course, we cover cervical anatomy, examination, differential diagnosis, advanced treatment strategies, case studies, and more!

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References:
1. Kadanka Z, Bednarík J, Vohánka S, Vlach O, Stejskal L, Chaloupka R, Filipovicová D, Surelová D, Adamová B, Novotný O, Nemec M, Smrcka V, Urbánek I. Conservative treatment versus surgery in spondylotic cervical myelopathy: a prospective randomised study. Eur Spine J (2000) 9 :538–544
2. Cleland JA, Fritz JM, Whitman JM, et al. Predictors of short-term outcomes in people with a clinical diagnosis of cervical radiculopathy. Phys Ther. 2007;87(12):1619-1632