How is it possible to have pressure on my spinal cord but not have any signs that there's a problem? I had an MRI for another problem and they found significant cord compression in my neck. But I don't have any pain or neurologic problems so far.
It appears that there are many conditions people can have that don't present with any particular signs or symptoms. It's not until they have an X-ray, CT scan, or MRI for something else that the problem shows up.
This tells doctors not to rely just on the results of clinical tests. A recent study confirmed this is true for cervical myelopathy. Cervical myelopathy is the technical term for spinal cord compression in the neck (cervical spine).
There are four common provocative tests that can be done to help diagnose cervical myelopathy. The main clinical tests used to look for cervical myelopathy include the Hoffman sign, inverted brachioradialis reflex, clonus, and Babinski. These are called provocative tests because the examiner applies some type of stimulus to the patient to evoke an abnormal response.
The Hoffmann sign is done by quickly snapping or flicking the patient's middle fingernail. A positive sign occurs if the tip of the thumb bends in response to this flicking. An inverted brachioradialis test is positive if, when the brachioradialis muscle is tapped with a reflex hammer, the fingers flex and the expected reflex is weak or absent.
Clonus is a rhythmic beating of the foot and ankle when the ankle is quickly and forcefully moved into a flexed position. The Babinski sign (when positive) is seen as an extension of the big toe (rather than flexion) and a fanning open of the other toes when the pointed end of the reflex hammer is used along the bottom of the foot from heel to toes.
It's been proven that doctors can't rely on signs of myelopathy to make the diagnosis. On the other hand, the lack of positive signs doesn't rule out the condition either. When the tests are positive, it's a pretty good indication that cord compression exists. The one group of patients that may not present like others is those who have diabetes.
Signs of myelopathy in adults with diabetes are very low. The reason for this is probably the decreased transmission of nerve impulses resulting in slower (not faster) reflexes. That's because diabetes affects the peripheral nerves most often.
In general, the appearance of these four signs is not necessarily an indication of how severe the cord compression is since it was possible to have severe compression without myelopathic signs. On the other hand, the more damage that is present in patient's spinal cords, the more likely it is that they have positive provocative signs.
Since the treatment of cervical myelopathy is often surgery, the decision to operate should be based on not just the presence of these clinical signs, but also the results of advanced imaging. Surgery may be needed even when provocative signs are negative because the MRI shows damage to the spinal cord.