What is Cervical Myelopathy?
Cervical myelopathy refers to compression on the cervical spinal cord. Any space-occupying lesion within the cervical spine with the potential to compress the spinal cord can cause cervical myelopathy.
Causes of Cervical Myelopathy
While age is the most probable cause of cervical myelopathy in patients, some other spine conditions may contribute to spinal cord compression:
• Herniated cervical disc: A herniated disc may bulge abnormally or rupture painfully. This may result in pressure on spinal cord or nerve roots.
• Rheumatoid arthritis: This is an autoimmune disease that causes inflammation in the joint membrane called the synovium. This inflammation can eventually destroy the facet joints in the cervical spine and cause unnatural movement of the vertebrae.
• Trauma: A sudden injury, such as a car accident or sports collision, can cause the hyperextension of the neck, which can compress the spinal cord.
Symptoms of Cervical Myelopathy
The symptoms of cervical spondylotic myelopathy depend on the level(s) of the spinal cord that are involved and the pattern of the involvement.
Symptoms may include:
• numbness of the hands
• clumsiness of the hands
• arm and/or hand weakness
• leg stiffness (“walking like a robot”)
• loss of balance
• urinary urgency
• neck pain–may be present but is not usually a significant complaint
The timing of the appearance of symptoms and progression varies from person to person. The rate of progression of symptoms may also change over time. Symptoms may progress rapidly for a period of time and then enter a period of stability. Alternatively, the symptoms may progress slowly but steadily.
How is Cervical Myelopathy Diagnosed?
The earlier cervical myelopathy is diagnosed, the more successful the treatment is expected to be. However, cervical myelopathy symptoms are not unique to this condition and are often mistaken for “normal” signs of aging.
To diagnose cervical myelopathy, your doctor may:
• Conduct a physical examination and measure your muscle strength and reflexes.
• Conduct further tests, including an MRI scan, an X-ray or a CT myelogram of your neck.
• Conduct electrical tests to measure how well the nerves in your arms and hands communicate with your brain through the spinal cord.
Treatment of Cervical Myelopathy
There are some nonsurgical options for relieving cervical myelopathy symptoms, including physical therapy and a cervical collar brace. However, to eliminate the compression of the spinal cord and prevent worsening of the condition, surgery is often necessary.
There are a few surgical procedures your doctor may recommend for treating cervical myelopathy. Widening of the spinal canal (laminoplasty) can be a good motion-sparing option for some patients. Others may benefit from spine decompression surgery with spinal fusion, which is meant to stabilize the spine after herniated discs, bone spurs or ossified ligaments are fully or partially removed.
These surgeries can be performed from the back of the neck (posteriorly) or from the front of the neck (anteriorly). Your doctor will recommend a specific surgery approach based on your situation.