Which examination finding best indicates myelopathy?

• A. Localized back pain without neurologic signs.
• B. Normal deep tendon reflexes with no UMN signs.
• C. Hyperreflexia, clonus, positive Babinski, gait disturbance, hand clumsiness, and UMN signs.
• D. Muscle wasting with LMN signs.

Answer: (C)

Myelopathy is spinal cord dysfunction that disrupts the brain’s control over muscles, so you see upper motor neuron (UMN) signs. The most telling exam pattern is the combination of hyperreflexia, clonus, and a positive Babinski sign, along with gait disturbance and hand clumsiness. These findings reflect loss of inhibitory input to the corticospinal tract and other UMN pathways, leading to increased reflexes, involuntary rhythmic muscle responses with certain stretches, and an abnormal plantar response. The gait changes show broader motor system disruption, and hand clumsiness highlights involvement of pathways controlling fine hand movements.

This is what sets myelopathy apart from other conditions. Localized back pain without neurologic signs would not indicate cord involvement. Normal reflexes with no UMN signs suggest the spinal cord isn’t affected in a way that changes descending control. Muscle wasting with LMN signs points to peripheral nerve or anterior horn cell problems rather than spinal cord pathways.