What exam finding differentiates cervical myelopathy from radiculopathy?

• A. Positive Spurling's test
• B. Upper motor neuron signs such as hyperreflexia and Babinski
• C. Loss of all sensation below clavicle
• D. Decreased range of motion

Answer: (B)

The main idea is that cervical myelopathy involves compression of the spinal cord itself, so you see signs from the long tracts that run through the cord. Upper motor neuron signs—like hyperreflexia and a Babinski response—indicate corticospinal tract involvement below the level of the lesion, which is characteristic of myelopathy. Radiculopathy, by contrast, results from compression of a nerve root and produces focal symptoms in a specific dermatomal and myotomal distribution, often with radicular pain, but it typically lacks these long-tract UMN signs. Spurling’s test being positive points toward nerve root irritation (radiculopathy) rather than cord compression, so it doesn’t differentiate myelopathy. A sensory level below the clavicle can occur with myelopathy but isn’t as reliable a discriminator, and decreased range of motion is nonspecific. Hence, the exam finding that best differentiates is the presence of upper motor neuron signs like hyperreflexia and Babinski, reflecting spinal cord involvement.