What is Cervical Myelopathy?
Cervical myelopathy is a condition caused by compression of the spinal cord. More specifically, cervical myelopathy refers to compression of the spinal cord in the cervical spine. In comparison to cervical radiculopathy, which is compression of the individual nerves after they have left the spinal cord, cervical myelopathy refers to compression of the spinal cord itself.
There are several causes of cervical myelopathy, but it is most commonly due to degeneration (wear and tear) of the cervical spine that leads to pressure on the spinal cord. It can also be caused by cervical disc herniation, infection, tumor, trauma, among others. The spinal cord lies in the spinal canal which is a tubular area designed to protect the spinal cord. Some people are born with a large, wide open spinal canal and some people are born with a smaller, narrow canal – called congenital spinal stenosis. People with congenital spinal stenosis are more prone to developing cervical myelopathy since the spinal cord has less space before compression occurs.
What symptoms are caused by cervical myelopathy?
Cervical myelopathy can cause a wide variety of symptoms. It is common to experience some degree of neck pain, because usually there is some degeneration in the neck that has caused a spinal cord compression. In addition to neck pain, patients often experience clumsiness of the hands and difficulty with fine motor function. Cervical myelopathy can cause difficulty buttoning shirts and cause handwriting changes. Patients may also experience some numbness or weakness in the hands or arms. In addition to these symptoms, patients may experience difficulty with balance. They may find that walking on uneven terrain is more difficult than it used to be for them, or they may require the use of rails when going up and down stairs. In more severe forms of cervical myelopathy, patients may require the use of canes or walkers to maintain balance. Severe cases of spinal cord compression can cause some disturbances with a patient’s bowel or bladder function.
How is cervical myelopathy diagnosed?
Cervical myelopathy is diagnosed based on the patient’s symptoms in combination with imaging. When patients have the symptoms suggestive of cervical myelopathy, an MRI is usually obtained. When the patient has appropriate symptoms and also have an MRI or CT scan that shows spinal cord compression, the diagnosis of cervical myelopathy is made.
How is cervical myelopathy treated?
The treatment for cervical myelopathy depends upon how severe the symptoms are and if the symptoms are progressing. If symptoms are very mild, observation is reasonable. Cervical myelopathy tends to gradually progress in a stepwise manner of decline. For example, a patient may function at baseline for a variable period of time and then seemingly rapidly will experience deterioration of symptoms, and then they establish a new baseline. This new baseline may exist for weeks, months, or even years before the next period of decline.
For myelopathy that is severe or progressive, treatment is to surgically take the pressure off the spinal cord. This can be achieved from an anterior approach (the front of the neck), from a posterior approach (the back of the neck), or sometimes a combination of both. The approach used depends upon the location of the patient’s compression, the spinal alignment, as well as a couple other factors. The x-rays, MRI, and CT scan will be beneficial in determining the surgical plan if surgery is necessary.