🧠 Myelopathy = any disorder affecting the spinal cord.
🔎 Suspect when bilateral neurological signs are present in arms and legs.
Lesion Location:
- ⬆️ Above L1 → spinal cord + roots affected.
- ⬇️ Below L1 → nerve roots only (➡️ Cauda Equina Syndrome).

🧩 Cord Lesions and Clinical Correlation

Lesion Type	Causes	Clinical Features
Extradural	💉 Metastases (breast, prostate, lung), myeloma, lymphoma, abscess, haematoma, trauma	⚡ Severe local back pain, spastic paraparesis, hyperreflexia, bladder involvement late
Intradural Extramedullary	🧬 Meningioma, neurofibroma (dumbbell lesion)	💪 Corticospinal weakness, spasticity, sensory loss (especially pain/temp), preserved dorsal column early
Intramedullary	🧪 MS, B12 deficiency, syringomyelia, infarction	🟥 Complete Transverse: Bilateral motor + sensory loss; flaccid → spastic. 🟧 Anterior Cord: Motor + pain/temp loss; preserved vibration/position. 🟨 Posterolateral: Dorsal column + corticospinal loss (B12, MS, HIV). 🟦 Central Cord: “Cape-like” sensory loss over shoulders/arms; syrinx, hyperextension injuries.

⏱ Onset Patterns

⚡ Instant: Trauma, haemorrhage (AVM rupture, anticoagulation).
⏳ Hours: Infective abscess, transverse myelitis, inflammation.
🐢 Weeks: Tumour growth, cervical spondylosis, degenerative stenosis.

🩺 Clinical Features

🚶 Progressive leg stiffness, fatigue, worsening gait.
🩸 Urinary urgency, frequency, incontinence (late feature).
🎯 Thoracic “band-like” sensory level helps localise lesion.
⚡ Lhermitte’s sign: electric-shock sensation down spine on neck flexion (esp. cervical lesions/MS).
📍 Back pain localises extradural lesions (mets, abscess).

📍 Clinical Localisation by Level

Cervical Spine:
- C5 → radial forearm loss, ↓ biceps reflex.
- C6 → thumb/index finger loss, ↓ biceps/brachioradialis reflex.
- C7 → middle/ring finger loss, ↓ triceps reflex.
- C8 → little finger loss, reflexes often normal.
Thoracic (T1–T12): Sensory band, no limb weakness, can mimic angina/chest pain.
Lumbar:
- L2 → anterior/lateral thigh sensory loss.
- L3 → medial thigh loss, ↓ knee jerk.
- L4 → medial shin loss, ↓ knee jerk.
- L5 → lateral shin/foot loss, usually intact reflexes.
- S1 → lateral foot sensory loss, weak gastrocnemius, ↓ ankle jerk.

🧾 Levels of Lesion Examples

🟢 C4–C5 → quadriplegia ± diaphragm weakness (risk of ventilatory failure).
🟡 T1 → upper limbs preserved, bilateral leg weakness/spasticity.

🔬 Causes of Myelopathy

🚨 Acute cord compression (emergency)
💿 Central disc prolapse
🧫 Epidural abscess
🧩 Transverse myelitis
❤️ Spinal cord infarction
🦴 Cervical spondylotic myelopathy (most common in UK adults)
🌊 AV malformation of cord

🧪 Investigations

🧬 Bloods: B12, folate, HIV, syphilis, inflammatory markers.
🖥 MRI (gold standard): defines compression, intramedullary lesions.
🩻 CT: useful for bone pathology if MRI contraindicated.
📡 X-ray: bony alignment, degenerative disease.
💉 CSF: oligoclonal bands (MS), infection.
⚡ EMG/NCS: helps exclude motor neuron disease, peripheral causes.

💊 Management

🚨 Red Flags: Acute cord compression = URGENT MRI + neurosurgical/orthopaedic referral. Delay can cause permanent paralysis.

Preventive Care:
- 🛏 Skin care → prevent pressure sores.
- 🦵 Physiotherapy/passive limb movement → prevent contractures.
- 🧦 Compression stockings / LMWH → DVT/PE prevention.
Bladder & Bowel:
- 🚽 Catheterisation (acute/retention); intermittent self-catheterisation long term.
- 🥦 Hydration, fibre, laxatives for bowel control.
Symptom Control:
- 💊 Baclofen or tizanidine for spasticity.
- ❤️ Address sexual dysfunction, fatigue.
- 🙂 Psychological support (depression/anxiety common).
Long-Term:
- 🦽 Wheelchairs, mobility aids, home adaptations.
- 🛠 Occupational therapy for ADLs and equipment.
- 🤝 Multidisciplinary team: physio, OT, continence nurse, neurology.

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Myelopathy (Disorder of Spinal cord)

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