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Diagnosis and Management of Cervical Myelopathy

Teaser: 

Sean Christie, MD, MSc, FRCSC,1 Aaron S. Robichaud, MD,2

1Associate Professor, Department of Surgery (Neurosurgery), Department of Medical Neurosciences, Dalhousie University, Halifax, Nova Scotia.
2Clinical Fellow, Department of Surgery (Neurosurgery), Department of Medical Neurosciences, Dalhousie University, Halifax, Nova Scotia.

CLINICAL TOOLS

Abstract: Cervical myelopathy is a degenerative disease that occurs secondary to direct spinal cord compression and compromise of spinal vasculature through a process of gradual spinal canal narrowing. Patients generally present with signs and symptoms of long tract compromise. Once myelopathy is suspected on clinical grounds, MRI is the test of choice to confirm canal stenosis and cord injury. Treatment involves surgical decompression, anteriorly and/or posteriorly of the spinal. Despite optimal management in this patient population, outcomes may be poor and are usually limited to halting progression of the disease rather than relieving deficits already present.
Key Words: Cervical myelopathy, cervical stenosis, degenerative spine disease, spondylosis.

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Pre-test CME Quiz Post-test CME Quiz
Cervical spondylotic myelopathy is a degenerative disease that results from compression of the spinal cord with subsequent cord injury and impaired conduction along the tracts contained within it.
Myelopathy is a clinical diagnosis based on signs and symptoms of spinal cord dysfunction and should not be used to refer to isolated imaging findings of spinal cord degeneration or stenosis.
MRI is the most sensitive test to identify cervical canal stenosis and injury to the cord and should be arranged when myelopathy is found on clinical evaluation to identify a specific diagnosis and guide management.
Surgical decompression can prevent progression of cervical spondylotic myelopathy, and in some patients improve gait and hand function.
Cervical myelopathy can be differentiated from radiculopathy on clinical exam by the presence of upper motor neuron signs as a result of injury to the spinal cord, which will be absent in radiculopathy.
MRI is helpful in working up cervical spondylotic myelopathy as it allows visualization of the elements causing compression, provides an estimate of the extent of stenosis through loss of CSF space surrounding the cord, and allows identification of cord injury manifest as hyperintense signal change in the cord on T2 weighted imaging.
Patients with symptomatic cervical myelopathy should be referred to a spine surgeon for evaluation and management.
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Related Terms: Back Health, Cervical myelopathy, cervical stenosis, degenerative spine disease, spondylosis

Non-Muscle-Invasive Bladder Cancer: Review of Diagnosis and Management

Non-Muscle-Invasive Bladder Cancer: Review of Diagnosis and Management

Teaser: 

Neil Pugashetti,1 Shabbir M.H. Alibhai,3 Stanley A. Yap,1,2

1Department of Urology, University of California, Davis, Sacramento, CA.
2Division of Urology, Department of Surgery, VA Northern California Health Care System, Sacramento, CA, USA.
3Department of Medicine, University of Toronto, Toronto, Ontario, Canada.

CLINICAL TOOLS

Abstract: Non-muscle-invasive bladder cancer (NMIBC) represents the large majority of newly diagnosed bladder tumors and represents a significant burden to both patients and the healthcare system. Although the initial standard treatment for all non-muscle-invasive tumors is surgical resection, there exist a wide variety of both surgical and medical treatment modalities based upon the tumor's specific stage and grade. Ensuring a proper diagnosis is key, and management should be tailored to the individual in order to reduce cancer recurrence and prevent progression of disease.
Key Words: Bladder cancer, non-muscle-invasive, diagnosis, treatment.

Members of the College of Family Physicians of Canada may claim MAINPRO-M2 Credits for this unaccredited educational program.

www.cfpc.ca/Mainpro_M2

You can take quizzes without subscribing; however, your results will not be stored. Subscribers will have access to their quiz results for future reference.

Pre-test CME Quiz Post-test CME Quiz
Non-muscle-invasive bladder cancer consists of papillary tumors (Ta), tumors invading the submucosal lamina propria (T1), and flat lesions known as carcinoma in situ (CIS).
Proper management is key given the significant risk of tumor recurrence or progression to muscle-invasive disease.
Many treatment modalities exist including transurethral resection, intravesical chemotherapy, intravesical immunotherapy, and radical cystectomy; treatment choice depends on a variety of factors including tumor stage and grade.
The gold standard for the complete work-up of hematuria is office cystoscopy and imaging of the upper urinary tract.
Initial standard treatment of non-muscle-invasive bladder tumors is TURBT; at the time of resection, sampling of muscle surrounding the lesion is important to accurately assess depth of invasion.
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Related Terms: Cancer, bladder cancer, diagnosis, treatment, non-muscle-invasive