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Diagnosing CSM

Every patient is different with respect to the nature, length and severity of symptoms and the cord compression, and the previous medical history. In some cases, the surgeon will ask for further tests to reach a decision, in other cases a recommendation for or against surgery can be made during the initial appointment.

It is not uncommon that CSM is diagnosed as part of a rapid deterioration, potentially related to a fall. Under these circumstances, a referral should be made as soon as a diagnosis has been confirmed with adequate imaging. Increasingly, it is recognized that a rapid deterioration of symptoms warrants early surgery.

Aim of a consultation with a doctor will be to establish:

1) to what extent the symptoms are due to CSM

2) whether the disease will benefit from surgical treatment at that time.

General Myelopathy Considerations

A doctor will consider three elements when formulating a diagnosis.

The backstory
Typically the time course is often long and hard to recognise when symptoms first started. The doctor will want to distinguish other causes of similar symptoms, e.g. as a result of trauma or infection, or other neurological disease.

The symptoms
CSM can cause a variety of symptoms, from pain to paralysis. Your doctor will want to know what symptoms you attribute to your CSM, including when you first noticed them, how they have progressed over time, how they affect you and how you manage them.

The extras
Patients often arrive at consultation having had CSM for a very long time. Doctors will want to know whether any tests have already happened. Given CSM sometimes requires an operation, they will also need to know what other medical conditions you may suffer from and what types of medication you take, as this will be important for any general anaesthetic.

The cervical part of the spinal cord controls everything in your body from the neck downwards. During your consultation, your doctor will carry out a careful assessment of this, particularly focussing on your arms and legs. The examination will involve:

  • testing your muscle strength
    testing your reflexes [tapping parts of your body with a hammer]
  • testing your sensation [does a pin feel sharp for example]
  • testing your stiffness [moving your limbs whilst you leave them completely relaxed]

MRI is the mainstay of diagnosis. It is a type of body scan, which uses magnets to image inside the body. It is able to provide excellent pictures of the spinal cord, ligaments and bones.

Due to the magnets, patients who have certain types of metal implanted from previous operations are not able to undergo an MRI. In these circumstances alternative tests are used.

See our MRI Checklist to see if you are able to have a MRI.

Other investigations that may be used.

  • Xrays – these can highlight bony arthritic changes, but will not show the spinal cord
  • CT Scan – this a special type of 3D X-ray, so once agin it will highlight the bony arthritic changes, but does not allow visualisation of soft structures such as the spinal cord.
  • CT Myelogram – this is the use of CT whilst dye is injected into your back. This allows the X-rays to see the spinal cord.
  • Nerve Conduction Studies – assessment of how well electricity is passing down the nerves in your arms and legs. This allows a radiculopathy to be distinguished from a myelopathy when there is any doubt.

Preparing for your consultation?

Is it safe for you to have a MRI?