Nielsen and Darnek identified risk factors for cervical flexion myelopathy. Early diagnosis may permit interventions that can reduce injury, while a delay in diagnosis can be devastating for the patient. The authors are from the University of Colorado Denver.


Cervical flexion myelopathy occurs with prolonged extreme flexion of the neck. The patient may present with hemiplegia or quadriplegia with loss of sphincter control.


The mechanism is uncertain but there is evidence of ischemic and/or compression injury to the spinal cord.


Risk factors include prolonged flexion of the neck (usually with the person seated) associated with:

(1) neurologic surgery with the patient seated and the neck flexed

(2) drug overdose

(3) prolonged assault

(4) prolonged loss of consciousness from other cause


The diagnosis may be delayed if:

(1) the patient is unconscious or has altered mental status

(2) imaging studies of the spinal cord delayed

(3) normal motion at presentation

(4) the prolonged nuchal flexion is not known


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