Which of the following best describes signs of posterior cord compression in myelopathy?

• A. Headaches, stiffness, shoulder pain.
• B. Pain, pathological reflexes, hyperactive DTR, motor weakness.
• C. Loss of dexterity, gait abnormalities, poor coordination, clumsiness, sensory loss.
• D. Drop attacks, dizziness, dysphagia.

Answer: (C)

Posterior columns carry vibration sense, fine touch, and proprioception, which are essential for sensing limb position and movement. When these pathways are compressed in myelopathy, the result is sensory ataxia and impaired coordination. Patients lose precise position sense, struggle with fine motor tasks, and show gait abnormalities and clumsiness due to the inability to feel where their limbs are in space, along with sensory loss in a pattern consistent with dorsal column disruption. Headache, stiffness, or localized shoulder pain don’t specifically reflect dorsal column function, and hyperactive reflexes or other motor signs point to corticospinal tract involvement rather than isolated posterior column loss. Similarly, dizziness, dysphagia, or drop attacks are more suggestive of brainstem or vestibular pathology. Thus, the signs described—loss of dexterity, gait abnormalities, poor coordination, clumsiness, and sensory loss—best represent posterior cord compression.