Which clinical signs are most indicative of myelopathy rather than radiculopathy?

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Multiple Choice

Which clinical signs are most indicative of myelopathy rather than radiculopathy?

The key idea is distinguishing spinal cord involvement (myelopathy) from nerve root involvement (radiculopathy). Myelopathy produces upper motor neuron signs because the long pathways in the spinal cord are affected. Hyperreflexia and a Babinski sign are classic UMN indicators, reflecting corticospinal tract disruption within the cord, which points to myelopathy. Radiculopathy, by contrast, involves a nerve root and tends to cause dermatomal sensory loss, radicular pain, and reflex changes limited to the affected root. A positive straight-leg raise test signals nerve root irritation, not cord involvement, and localized thoracic spine tenderness is non-specific to cord pathology. So the combination of hyperreflexia and Babinski best indicates myelopathy.

The key idea is distinguishing spinal cord involvement (myelopathy) from nerve root involvement (radiculopathy). Myelopathy produces upper motor neuron signs because the long pathways in the spinal cord are affected. Hyperreflexia and a Babinski sign are classic UMN indicators, reflecting corticospinal tract disruption within the cord, which points to myelopathy.

Radiculopathy, by contrast, involves a nerve root and tends to cause dermatomal sensory loss, radicular pain, and reflex changes limited to the affected root. A positive straight-leg raise test signals nerve root irritation, not cord involvement, and localized thoracic spine tenderness is non-specific to cord pathology. So the combination of hyperreflexia and Babinski best indicates myelopathy.

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