Degenerative cervical myelopathy is the commonest cause of spinal cord impairment in adults, and it is often missed for months because early symptoms are vague: clumsy hands, difficulty with buttons or handwriting, numb fingers, and a gait that feels unsteady. Neck pain may be absent.
On examination, look for brisk reflexes, a positive Hoffmann sign, an inverted supinator jerk, and difficulty with tandem gait. Ask for MRI of the cervical spine when these appear, and refer for spinal surgical opinion if myelopathy is confirmed. Established deficits often persist after decompression, which is why timing matters.
- Ask about hand clumsiness, dropped objects and change in handwriting in older adults with gait complaints
- Check for hyperreflexia, Hoffmann sign and inverted supinator jerk
- Request cervical MRI when upper motor neuron signs appear
- Refer promptly once myelopathy is confirmed, since established deficits often persist after surgery
Why it matters
Delay converts a treatable compression into a permanent deficit.
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