cervical myeloradiculopathy

1. By M.Hemasree
16H61T0012
Pharm D 3rd year

2.  Definition : Cervical myeloradiculopathy is the
dysfunction of the spinal cord (myelopathy) and
nerve root (radiculopathy).
 Cervical myelopathy is loss of function in your
upper and lower extremities because of
compression of the spinal cord which involves
your arms, hands, legs, bowel and bladder
function.
 Cervical radiculopathy often called “pinched
nerve” occurs when a nerve in your neck is
compressed or irritated where it branches away
from spinal cord. Pain radiates into shoulder,
muscle weakness, numbness that travels down
your arm and into your hand

3. Etiology
 The dysfunction is due to compression of
spinal cord and nerve root.
 Compression can arise from:
 Facet osteophytes(overgrowth of bone)
 Disc herniation(slip disc)
 Ossification of posterior longitudinal
ligaments(degenerative deposition of bone
within ligaments).
 On rare occasion, the compression can be
caused by tumors, infections, fractures of
vertebrae

4. Pathogenesis
Produce direct damage and often secondary ischemic changes,
excititoxicity and apoptosis.
Decrease in diameter of vertebral column secondary to disc
degeneration and osteophytic spurs.
Result in acquired or developmental stenosis of cervical canal
and repititive injury to spinal cord and nerve respectively.
Static factors and dynamic factors.

5. Signs and symptoms
 Heavyness in the legs or arms
 Inability to walk for long
 Difficulties in writing,buttoning or holding
things
 Intermittent shooting pain to arms and legs.
 Urinary and bowel disturbances
 Losing your body consciousness
 Numbness or weakness in the
corresponding muscles in your arm,
forearm or hand

6. DIAGNOSIS
 Physical examination
 Cervical spine radiography to look for
instability
 MRI scan to determine cause of compression
 X-Ray and CT scan
TREATMENT
 Ice or heat applied to affected area
 Anti-inflammatory drugs, Muscle relaxants,
narcotic painkillers
 Epidural steriod injections
 Physical therapy, occupational therapy,
lifestyle changes
 surgery

7. SOAP ANALYSIS
1. SUBJECTIVE DATA:
A 58 years old male patient of 70kg was admitted in general ward
on 24/11/2018 presented with complaints of increased urine output,
B/L, UL and LL pain, tingling sensation, difficult in walking.
History of past illness:
K/C/O Hypertension, diabetes mellitus.
Past surgery:
S/P Lap appendectomy – 15 years back.
C4 – C5 , C5 – C6 , PIVD
Personal and family history: nothing contributory

8. Objective Data
 Vital signs
Parameters Normal
value
Day 1 Day 2 Day 3
Blood
pressure(mmHg)
130/90 130/70 140/80 120/80
Temperature(F) 98.6 98.6 98.6 98.6
Pulse rate(bpm) 60-100 89 90 97
Respiratory
rate(cpm)
20 20 20 20

9.  Lab investigations
Test Normal range Results
Haemoglobin 12-16 gms% 15.10
RBC count 3.8-5.8 million/cumm 5.08
PCV 36-50% 45%
Platelet count 1-4 lac cells/cumm 2lacs/cumm
Total WBC count 4k-10k cells/cumm 7,480cells/cumm
Neutrophils 40-70% 75.30%
Lymphocytes 15-30% 18.40%
Eosinophils 1-6% 2.20%
Monocytes 2-10% 5%
Basophills 0-1% 0%
ESR 0-10mm 3.0mm
PT 10-13 sec 12.1sec

10. Clinical pathology
Test Normal range Result
Colour Pale yellow Pale yellow
Appearance Clear Clear
Albumin Nil Nil
Sugar Nil Nil
Ketone Negative Negative
Bile salts Absent Absent
Bile pigments Negative Negative
Uric acid crystals 0-1 Nil
Bact cocci 0-29 Nil
Bact bacilli 0-29 9
Mucus particles 0-60 3

11. Electrolytes
 X-Ray chest PA view:Normal
 2D ECHO:Normal
 ECG:normal
Test Normal range Result
Sr.sodium 135-145mEq/L 136
Sr.potassium 3.5-4.5mEq/L 4
Sr.chloride 98-107mEq/L 100

12. MRI Cervical spine
 Technique: T1-T2 saggitals, T1 axials
GRE axials, IR coronals
 Findings :
 Reduced disc height at c4-c5, c5-c6 levels
 Anterior osteophytes at c4-c5 levels noted
 Subtle hypertrophy causing posterior thecal sac
indentation seen at C4-C5 levels
 Mild moderate annular disc bulge with ventral thecal
sac compression and cord compression at C4-C5
levels
 s/o cord ischemia, myelomalacia changes
 Spinal cord narrowing at C3-C4 LEVELS, C4-C5 and
C5-C6 levels

13. ASSESSMENT
Based on the subjective and
objective data the patient was diagnosed with
“CERVICAL MYELORADICULOPATHY”.

14. PLAN
 Medication chart
Drug Generic
name
Dose ROA Freq D-1 D-2 D-3 D-4 D-5
Tab
Gabiver NT
gabapentin+
Nortryptyline
1tab PO HS + + + + +
Tab
transnerv
Methylcobal
min+
pregabalin
1tab PO OD + + + + +
Tab MET-
XL
metoprolol 25mg PO OD + + + + +
Inj Supacef cefuroxime 1.5g IV BID + + + + +
Inj Pan pantoprazole 40mg IV OD + + + + +
Inj
Perfalgan
paracetamol 1g IV TID + + + + +
Inj zofer ondansetron 4mg IV TID + + + + +

15. Drug MOA Uses Side
effects
Tab Gabiver NT Gabapentin crosses BBB and
enhances GABA release by
binding to lipophilic molecule.
Nortryptiline acts by inhibiting
uptake of noradrenaline and
5-HT resulting in increased
conc of neurotransmitters in
synaptic cleft
Epilepsy,
relieve
numbness,
tingling
sensations
Weakness,
stomach
pain
Tab Transnerv It act as a cofactor for
enzyme methionine synthase
and vit B12
Neuropathic
pain,
numbess
Nausea,
dizziness,
diarrhea
Tab MET-XL It blocks beta 1 adrenergic
receptors in heart muscle
cells, slows heart rate, BP
and relaxes blood vessels
To treat high
blood
pressure
Chest pain
and
discomfort,
tiredness,
depression

16. Drug MOA Uses Side effects
Inj Supacef It works by inhibiting
the bacterial cell wall
Bacterial
infections,
UTI,
pharyngitis
Diarrhea,
nausea,
headache
Inj PAN Inhibits final step in
gastric acid production
by covalently binding to
ATPase k+/H+ ions
Antacid Headache,
altered sense of
taste, rhinorrhea
Inj Perfalgan Increase pain threshold
by inhibiting COX
enzymes
Pain killer
anf anti-
pyretic
Allergic rxn,
SOB, nausea,
rashes
Inj Zofer Blocks serotonin
receptors CTZ
decreases
communication to
vomiting center
Nausea
and
vomitting
Headache,
painfull urination

17. Goals of treatment
 To provide symptomatic relief.
 To relive pain and help to maintain usual
activites
 To prevent permanent injury to spinal cord
and nerves.
Problems identified
 Drug-drug interactions
 Nortryptyline+ondansetron(major)
 Have increase risk of serotonin syndrom
include symptons like confusion,
hallucination.
Management: Discontinue serotonin agents
and supportive therapy given

18.  Cefuroxime + pantoprazole
 PAN decrease stomach acid leading to
decrease absorption of cefuroxime
Management: Avoid PPI,H2 receptor blockers
or an alternative antibiotic is given
 Metoprolol + Nortryptyline
 They both have additive effects in lowering
your bp hence may lead to headache,
dizziness
Management : close monitoring of
hypotension and caution is advised

19.  Drug – Food interactions
Metoprolol + Food ( Moderate)
 Bioavailability metprolol enhance by food
 Management : Patient must be instructed
to take metprolol at same time each day
with or immediately after meals
Pregabalin / Gabapentin + Alcohol
 Alcohol may potential CNS active agents
causing CNS depression or impaired
judgement
 Management: Avoid consumption of
Alcohol or limit the use

20. PATIENT COUNSCELLING
 About the disease
Patient must be expalin about
diesease condition ( Cervical
myeloradiculopathy) that there are
chances of loss of funcntion in upper and
lower extremities because of compression
of spinal cord or nerve that arise from
spinal cord

21. LIFE STYLE
MODIFICATIONS
 Perform neck stretching exercises
 Ice or heat applied to the effected area
 Stop looking on your phone or computer
for long periods of time
 Moderate strength building exercises to be
done
 Keep finding the best pillow and try to
sleep in your back
 Maintain good posture and carry weight
evenly

22. DIET
 Food to be taken:
 Eat calcium rich food which include cheese,
milk, yogurt, and vegitables like spinach
 Omega-3- fatty acid found in fish, flax seeds,
walnuts, lower inflammatary chemicals in the
body
 Megnesium found in fruits, nuts, beans, soya
and whole grains
 Food to be avoid:
 High fat products like butter, cream and meat
 Refined and processed foods
 Fewer intake of acidic foods like citrus fruits
and coffee as they interfere during healing
process

23. PRECAUTIONS
 Follow the medications as per the
prescription
 Do not miss the dose
 Do not double the dose, If missed
 If any serious side effect / ADR’s are
seen report, to the physician
immediately

24. References
 https://www.columbiaasia.com/malaysia/
health-articles/cervical-
myeloradiculopathy
 https://www.drugs.com/
 https://emedicine.medscape.com/article/
94118-overview

25. t