Spine

Cervical myelopathy

Mechanism: Compression of the spinal cord itself in the cervical canal, usually from a combination of disc protrusion, osteophytes and thickened ligamenta flava. Unlike a radiculopathy this involves not a root but the cord.
Recognition: Clumsiness of the hands, an unsteady gait and symptoms in all four limbs. On examination brisk reflexes, a positive Babinski sign and a positive Romberg test.
Course: This is the most important red flag of the neck. Manipulation is contraindicated here and the patient belongs with the neurologist. The course is erratic but rarely spontaneously favourable.

Structures