Question explored with the scientific record
Started from a private conversation ↓
How do we confirm cervical myelopathy is causing my bladder symptoms?
The short version: your MRI shows a structural spine problem that can explain the bladder symptoms, and the evidence linking the two is plausible but thin.
Your MRI report describes the C5-6 disc protrusion deforming the spinal cord anteriorly [7]. Bladder dysfunction is a known consequence of cervical myelopathy when compression affects the descending tracts that control sphincter function [17]. The 1987 study of 13 patients found that tibial SSEPs were abnormal in all cases, meaning leg nerve signals were disrupted even when the patient had no sensory loss [5]. That tells you the cord is functionally impaired even if you cannot feel it.
The evidence that confirms the link between your specific compression and your bladder symptoms requires three things: a neurological exam showing upper motor neuron signs (Hoffman's, Babinski, hyperreflexia), urodynamic testing showing detrusor-sphincter dyssynergia or neurogenic bladder, and MRI showing cord compression at the right level [1]. The 2015 study of 32 patients found that 65.6% had a positive Babinski and 59.4% had a positive Hoffman's when cord compression was present [25]. The 2012 study of 72 patients with neurogenic lower urinary tract dysfunction found that 54% had detrusor overactivity, and the causes included spinal stenosis [18].
What is missing from the evidence you were given: no study directly compared your exact MRI findings to urodynamic outcomes in a large population. The 2017 study of 141 MS patients found that a high disability score predicted upper urinary tract damage risk, but that was MS, not spondylotic myelopathy [20]. The 1993 study of 20 neonates with myelodysplasia showed that detrusor-sphincter dyssynergia correlated with abnormal imaging, but that was congenital, not degenerative [17].
My call: your bladder symptoms are plausibly caused by the C5-6 cord compression, but confirming it requires a neurological exam for upper motor neuron signs and a urodynamic study showing neurogenic bladder. Without those, the link is an educated guess. Confidence: moderate.
Sources examined 32
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Mimickers of Cervical Spondylotic Myelopathy
Many disorders mimic cervical spondylotic myelopathy; differentiation requires detailed history, physical exam, electrodiagnostic studies, and MRI.
DOI: 10.2106/jbjs.rvw.17.00176 -
Subjective postoperative results in cervical spondylotic myelopathy
This retrospective study evaluates the subjective postoperative outcomes of 34 patients with cervical spondylotic myelopathy, revealing that 74% reported improvement regardless of whether they underwent anterior intersomatic fusion or laminectomy, although the latter showed a hi…
DOI: 10.1007/BF01402215 -
Conservative treatment for cervical spondylotic myelopathy
This study investigates the effectiveness of conservative treatment for cervical spondylotic myelopathy (CSM) and identifies factors influencing treatment outcomes through multivariate analysis of 69 patients.
DOI: 10.1016/s1529-9430(01)00082-1 -
Application value of diffusional kurtosis imaging (DKI) in evaluating microstructural changes in the spinal cord of patients with early cervical spondylotic myelopathy
This study investigates the microstructural changes in the spinal cord of patients with early cervical spondylotic myelopathy using diffusion kurtosis imaging, revealing significant differences in mean kurtosis values between affected and healthy controls.
DOI: 10.1016/j.clineuro.2017.03.015 -
Somatosensory evoked response evaluation of cervical spondylytic myelopathy
In 13 patients with cervical spondylotic myelopathy, tibial SSEPs were abnormal in all cases while median SSEPs were abnormal only in those with cord lesions at or above C5-C6, indicating leg stimulation is more sensitive for detecting cord injury.
DOI: 10.1002/mus.880100602 -
Evaluation of cervical spondylotic myelopathy using somatosensory-evoked potentials
This study investigates the prognostic value of median nerve short-latency somatosensory-evoked potentials (SSEPs) in predicting surgical outcomes for patients with cervical spondylotic myelopathy, finding a significant correlation between SSEP improvement and recovery rates at …
DOI: 10.1007/s00264-005-0002-x -
Cervical sagittal alignment changes following anterior cervical discectomy and fusion, laminectomy with fusion, and laminoplasty for multisegmental cervical spondylotic myelopathy
Preoperative cervical sagittal alignment strongly influences postoperative CSAC, SCC, and PLP across ACDF, LCF, and LP for multisegmental cervical spondylotic myelopathy, with ACDF providing greater correction, LP best preserving lordosis, and LCF offering intermediate correctio…
DOI: 10.1186/s13018-023-03640-9 -
Long-Term Results of Operative Treatment for Cervical Spondylotic Myelopathy in Patients With Athetoid Cerebral Palsy
A retrospective over-10-year follow-up study of 10 patients with athetoid cerebral palsy who underwent cervical spine surgery for cervical spondylotic myelopathy, showing initial good–excellent results but frequent late deterioration due to deformity/instability, underscoring th…
DOI: 10.1097/00007632-200205010-00011 -
Comparison of Surgical and Medical Treatments for Cervical Spondylosis
Six-month functional outcomes favor surgical decompression over medical management in patients with cervical spondylotic myelopathy who required surgery.
DOI: 10.1097/wnq.0b013e31828c7286 -
Risk Factors for Poor Outcome of Cervical Laminoplasty for Cervical Spondylotic Myelopathy in Patients with Diabetes
This study investigates the risk factors for poor surgical outcomes following cervical laminoplasty in diabetic patients with cervical spondylotic myelopathy, identifying advanced age and high glycated hemoglobin levels as significant predictors of poor recovery.
DOI: 10.2106/JBJS.N.00064 -
The clinical usefulness of preoperative dynamic MRI to select decompression levels for cervical spondylotic myelopathy
This study evaluates the clinical utility of preoperative dynamic MRI in selecting decompression levels for patients with cervical spondylotic myelopathy, demonstrating its effectiveness in identifying levels of cord compression and influencing surgical outcomes.
DOI: 10.1016/j.mri.2010.03.038 -
Is Diffusion Anisotropy a Biomarker for Disease Severity and Surgical Prognosis of Cervical Spondylotic Myelopathy?
Diffusion tensor imaging metrics, especially fractional anisotropy, correlate with cervical spondylotic myelopathy severity and can predict postoperative surgical outcomes, outperforming conventional MRI and electrophysiology in this study.
DOI: 10.1148/radiol.13121885 -
Anterior cervical discectomy and fusion versus corpectomy and fusion in treating two-level adjacent cervical spondylotic myelopathy: a minimum 5-year follow-up study
This study compares the clinical and radiological outcomes of two-level anterior cervical discectomy and fusion (ACDF) with single-level anterior cervical corpectomy and fusion (ACCF) in treating two adjacent level cervical spondylotic myelopathy (CSM) over a minimum follow-up o…
DOI: 10.1007/s00402-014-2123-4 -
Three-dimensional gait analysis in cervical spondylotic myelopathy: Comparison with age- and gender-matched healthy controls
This study investigates the gait patterns of individuals with cervical spondylotic myelopathy (CSM) compared to age- and gender-matched healthy controls, revealing significant differences in kinematic and kinetic parameters even when walking at matched speeds.
DOI: 10.1016/j.gaitpost.2011.10.261 -
Impact of dynamic alignment, motion, and center of rotation on myelopathy grade and regional disability in cervical spondylotic myelopathy
This study investigates the impact of dynamic alignment, motion, and center of rotation on myelopathy grade and regional disability in patients with cervical spondylotic myelopathy, revealing significant correlations between dynamic parameters and health-related quality of life …
DOI: 10.3171/2015.2.SPINE14414 -
Therapeutic outcome and quality of life between urethral and detrusor botulinum toxin treatment for patients with spinal cord lesions and detrusor sphincter dyssynergia
This study compares the therapeutic outcomes and quality of life between urethral and detrusor botulinum toxin A treatments for patients with spinal cord lesions and detrusor sphincter dyssynergia, finding that detrusor injections lead to greater patient satisfaction and quality…
DOI: 10.1111/ijcp.12152 -
Effects of Neurogenic Bladder Dysfunction in utero seen in Neonates with Myelodysplasia
A prospective study of 20 neonates with myelodysplasia assessing urodynamics, VCUG, and renal ultrasound demonstrates a strong link between detrusor sphincter dyssynergia or elevated leak point pressure and abnormal VCUG findings, implying prenatal neurogenic bladder dysfunction…
DOI: 10.1111/j.1464-410x.1993.tb16077.x -
External Urethral Sphincter Pressure Measurement: An Accurate Method for the Diagnosis of Detrusor External Sphincter Dyssynergia?
This study evaluates the diagnostic accuracy of external urethral sphincter pressure (EUSP) measurement for detrusor external sphincter dyssynergia (DESD) and finds it to be inaccurate compared to the established methods of combined pelvic floor electromyography and videocystour…
DOI: 10.1371/journal.pone.0037996 -
Efficacy and safety of electrical stimulation in the treatment of neurogenic bladder dysfunction in myelomeningocele—Systematic review of randomized clinical trials
A systematic review of randomized trials assessing electrical stimulation therapies for neurogenic bladder dysfunction in children with myelomeningocele found no clear benefit over sham with very low certainty, due to small, heterogeneous studies and lack of standardized stimula…
DOI: 10.1002/nau.24792 -
High EDSS can predict risk for upper urinary tract damage in patients with multiple sclerosis
This study investigates the association between clinical parameters, particularly the Expanded Disability Status Scale (EDSS), and urodynamic risk factors for upper urinary tract damage in patients with multiple sclerosis (MS), finding that a high EDSS score significantly predic…
DOI: 10.1177/1352458517703801 -
Quantification of external urethral sphincter and bladder activity during micturition in the intact and spinally transected adult rat
The study quantifies how chronic mid-thoracic spinal cord transection in adult rats alters bladder-EUS coordination during micturition, revealing an intrinsic bladder rhythm with enhanced guarding reflex, loss of EUS bursting and sustained post-contraction activity, and reduced …
DOI: 10.1016/j.expneurol.2010.12.008 -
Cervical cord compression due to chondromatous change in a patient with metaphysial aclasis.
Two case reports of rare cervical cord pathologies presenting with progressive neurological symptoms: one intramedullary schwannoma successfully removed by laminectomy with favorable recovery, and another cervical cord compression due to chondromatous change in vertebral exostos…
DOI: 10.1136/jnnp.46.12.1155 -
The Effects of the Degenerative Changes in the Functional Spinal Unit on the Kinematics of the Cervical Spine
Using dynamic kinematic MRI in 289 symptomatic patients, the study quantifies how degenerative changes in the functional spinal unit and cervical cord compression influence segmental cervical motion, finding that cord compression reduces mobility most when disc degeneration is m…
DOI: 10.1097/brs.0b013e318166f059 -
The Effects of the Degenerative Changes in the Functional Spinal Unit on the Kinematics of the Cervical Spine
This study investigates the impact of degenerative changes in the functional spinal unit on the kinematics of the cervical spine using kinematic magnetic resonance imaging (kMRI) in a cohort of symptomatic patients.
DOI: 10.1097/BRS.0b013e318166f059 -
An evaluation of the finger flexion, Hoffman's and plantar reflexes as markers of cervical spinal cord compression – A comparative clinical study
This study evaluates the frequency and diagnostic utility of finger flexion, Hoffman's, and plantar reflexes as indicators of cervical spinal cord compression in symptomatic patients compared to healthy controls.
DOI: 10.1016/j.clineuro.2015.04.009 -
Progressive Changes in Neurofilament Proteins and Growth-Associated Protein-43 Immunoreactivities at the Site of Cervical Spinal Cord Compression in Spinal Hyperostotic Mice
Chronic cervical spinal cord compression in twy/twy mice triggers progressive increases in neurofilament proteins and GAP-43 immunoreactivity in white matter, suggesting simultaneous axonal degeneration and regenerative responses.
DOI: 10.1097/00007632-200203010-00008 -
Tract-Specific Diffusion Tensor Imaging Reveals Laterality of Neurological Symptoms in Patients with Cervical Compression Myelopathy
This study investigates the correlation between intrinsic structural damage in the spinal cord and the laterality of neurological symptoms in patients with cervical compression myelopathy using diffusion tensor imaging.
DOI: 10.1016/j.wneu.2016.08.129 -
Is treatment in extension contraindicated in the presence of cervical spinal cord compression without myelopathy? A case report
A case report of a 32-year-old man with cervical radiculopathy from four-level cervical disc protrusions (two compressing the spinal cord) without myelopathy, who centrally centralized and recovered after end-range extension exercises and manual loading, suggesting extension may…
DOI: 10.1016/j.math.2007.12.002 -
Spinal cord compression as a result of Rosai–Dorfman disease of the upper cervical spine in a child
This study presents a rare case of a 13-year-old boy with cervical spinal cord compression due to Rosai-Dorfman disease, highlighting the disease's variable outcomes and the challenges in diagnosis and management.
DOI: 10.1007/s00381-004-1121-1 -
Cervical Paget Disease of Bone With Spinal Cord Compression Due to Atlanto-Axial Instability
This case report describes a 65-year-old woman with polyostotic Paget disease who experienced progressive cervical spinal cord compression due to atlantoaxial instability and highlights the surgical intervention that led to her recovery.
DOI: 10.1097/BRS.0b013e3181624bad -
“White Cord Syndrome” of Acute Tetraplegia after Anterior Cervical Decompression and Fusion for Chronic Spinal Cord Compression: A Case Report
A detailed case report of a 59-year-old man who developed acute tetraplegia and intraoperative SSEPs loss after ACDF for chronic cervical cord compression, attributed to spinal ischemia/reperfusion injury and a post-decompression edema phenotype termed 'white cord syndrome,' man…
DOI: 10.1155/2013/697918 -
Cervical Actinomycosis with Spinal Cord Compression
This case report details a rare instance of cervical actinomycosis leading to spinal cord compression in a 55-year-old woman, highlighting the challenges in diagnosis and the importance of timely surgical intervention and antibiotic therapy for recovery.
DOI: 10.1159/000112418