Cervical myelopathy: symptoms requiring assessment without delay

Loss of fine dexterity is the earliest sign. Buttoning a shirt, taking a coin from a wallet, turning a key and writing become difficult.

Deterioration in handwriting is a change patients often notice. Writing becomes smaller or irregular, indicating loss of coordination rather than strength.

Clumsiness in the hands can appear without pain. Absence of pain does not make it unimportant; it is in fact typical in myelopathy.

A sense of insecurity when walking and unsteadiness are the second core sign. It is harder in the dark or on uneven ground.

Steps widen and gait stiffens. Relatives may notice the change before the patient, so family observation is taken into account in assessment.

Stiffness and heaviness in the legs can accompany it. As these are often attributed to the lower back and cause delay, they must also be investigated at neck level.

Cord tissue tolerates compression less well than nerve roots and has a more limited capacity to recover. Prolonged compression can cause permanent functional loss.

The aim of surgery here is usually to preserve existing function. Full return of lost function is not always expected, which makes timing decisive.

Changes in bladder or bowel control are a late finding and require urgent assessment. The aim is diagnosis before that stage.