Hand Wasting Due to Mid-Cervical Spinal Cord Compression

Abstract

Three patients presented with hand wasting and weakness secondary to mid-cervical spinal cord compression. This was due to cervical spondylosis in two patients and a meningioma in one case. This phenomenon is probably similar to that seen with foramen magnum lesions and may be due to spinal cord ischemia distal to the compression, secondary to venous stasis. RESUME: Atrophie de la main due a une compression medullaire localisee a la region cervicale moyenne. Trois patients ont consulte pour de l'atrophie et de la faiblesse a la main secondaires a une compression medullaire a la region cervicale moyenne. Cette symptomatologie etait due a une spondylose cervicale chez deux patients et a un meningiome dans l'autre cas. Ce phenomene est probablement semblable a celui que Ton rencontre dans les lesions du trou occipital et peut etre cause par I'ischemie de la moelle epiniere, secondaire a la stase veineuse, en aval de la compression.Can. J. Neurol. Sci. 1987; 14:309-311 Hand wasting has not been commonly reported with lesions of the middle cervical spinal cord 1 although it is a well known feature of compressive lesions at the foramen magnum.2 " 4 We describe three patients with hand wasting due to mid-cervical cord lesions and discuss the significance of this clinical finding.CASE HISTORIES Patient 1: This 41-year-old woman presented with a sixteen month history of wasting and weakness of her left hand which she first noted after a minor hand injury. She had minimal pain of the left side of her neck and left upper arm. This was not characteristic of radicular pain. On physical examination, movement of the neck was normal. There was marked wasting and weakness of all the intrinsic muscles in the left hand. There was slight wasting and weakness of the left forearm flexors and extensors. The sensory exam and remainder of the neurological examination was normal. The electrophysiological studies on the left revealed a slight reduction of the fifth digit sensory nerve action potential and active denervation in both the abductor pollicus brevis and the first dorsal interosseus. The motor conduction studies were normal in the median and ulnar nerves. X-Rays of the cervical intervertebral foramina were normal. The transverse processes of C7 were prominent bilaterally. A cervical myelogram revealed a large anterior extradural defect at C5-6 (Figure 1). She had an anterior cervical discectomy and fusion at C5-6. Post-operatively she had complete resolution of her preoperative pain and subjectively found that the function of the left hand had improved although no change in strength was noted. Repeat EMG seven months later showed improvement with less denervation in the thenar muscles. At follow-up four years later there was no evidence of any improvement in strength. Patient 2:This 44-year-old woman had an eight year history of pain extending from the right elbow to the wrist. For six years she had mild progressive weakness of the right hand and forearm muscles. There was no neck pain. Examination showed slight was...

Localization of the primary sites of involvement in the spinal sensory and motor pathways for multilevel MRI abnormalities in degenerative cervical myelopathy

“…The site of conduction block identified by the A-SCEP and the D-SCEP, whether the two studies revealed conduction block at the same single level (78 out of 83 patients) or at two separate levels (5 out of 83 patients), corresponded to the intervertebral level of sufficient degree of cord compression with MRI evidence of either the smallest anteroposterior diameter and cross-sectional area of the cord (for 81% of 88 conduction blocks) or the second smallest anteroposterior diameter and crosssectional area of the cord (for 19% of 88 conduction blocks). This finding indicates the functional importance of direct mechanical pressure on the white matter rather than vascular factors involving the gray matter remote from the site of compression, thus causing false localizing signs [12]. Measuring the absolute values of anteroposterior diameter and cross-sectional area of the cord has a limitation in estimating the degree of cord compression, because the spinal cord varies in size depending on the level; the anteroposterior diameter normally decreases, and the One-way ANOVA followed by Tukey HSD test is used for statistical analysis "0" represents the site of conduction block, with the other levels numbered in order of increasing distance from the "0" level, assigning a minus sign caudally Anteroposterior diameter of the cord was measured on midsagittal T1weighted MRI…”