Which combination of findings best characterizes cervical spondylotic myelopathy?

• A. Gait disturbance with hyperreflexia and Babinski
• B. Isolated neck pain without neurologic signs
• C. Numbness limited to the fingertip
• D. Unilateral weakness without spasticity

Answer: (A)

Cervical spondylotic myelopathy causes the spinal cord to be compressed in the neck, leading to signs of upper motor neuron dysfunction. When the cord is affected, walking becomes unsteady (gait disturbance) because motor and proprioceptive pathways in the cord are disrupted. The corticospinal tracts respond with increased reflex activity, so hyperreflexia appears. A Babinski sign—an upward extension of the big toe when the sole is stroked—directly reflects an upper motor neuron lesion. Together, gait disturbance, hyperreflexia, and a positive Babinski point to cervical myelopathy from cord compression.

The other scenarios fit more with localized nerve or tissue issues rather than spinal cord compression. Isolated neck pain without neurologic signs doesn’t indicate cord involvement. Numbness limited to the fingertip suggests a local sensory issue, such as radiculopathy or a peripheral nerve problem, not widespread cord compression. Unilateral weakness without spasticity implies a lower motor neuron process or radiculopathy rather than the bilateral, spastic signs typical of myelopathy.