About Cervical Myelopathy
Cervical myelopathy develops when pressure on the spinal cord in your neck causes dysfunction or damage to the nervous system. This condition could be caused by any issue that leads to damage, irritation, or inflammation of this portion of the spinal cord.
Several conditions can lead to cervical myelopathy:
- Cervical spondylosis: Age-related degeneration of the spinal joints in the neck (the most common cause)
- Herniated discs: When disc material pushes into the spinal canal
- Spinal stenosis: Narrowing of the spinal canal
- Bone spurs: Abnormal bone growth that encroaches on the spinal cord
- Spinal tumors: Abnormal growths that compress neural structures
- Traumatic injury: Acute damage from accidents or falls
The condition typically develops gradually as degenerative changes narrow the space around your spinal cord. Without treatment, cervical myelopathy can lead to permanent nerve damage and disability.
Symptoms
Early recognition of cervical myelopathy symptoms allows for timely intervention. The most common symptoms include hand numbness and clumsiness, particularly difficulty with tasks that require fine motor control, such as buttoning a shirt, along with unsteadiness while standing or walking.
Common symptoms include:
- Numbness and weakness of the arms or hands
- Coordination problems
- Muscle spasms
- Difficulty walking
- Tingling or burning sensations
- A sense of urgency when urinating
Many patients first notice hand clumsiness or difficulty with precision tasks. These symptoms often worsen gradually, making it easy to dismiss them initially. If you experience progressive weakness, numbness, or balance problems, schedule a consultation with a neurosurgeon.
Diagnosis
The first steps in diagnosing cervical myelopathy include a thorough clinical history and a comprehensive physical examination. Your neurosurgeon will evaluate your reflexes, muscle strength, sensation, and coordination to assess how well your spinal cord functions and identify the location of compression.
Imaging tests include:
- X-rays: Assess spinal alignment and joint degeneration
- MRI scans: Provide detailed images of soft tissues, including the spinal cord, discs, and nerves
- CT scans: Show bone structures and can reveal stenosis or bone spurs
- CT myelograms: Combine CT imaging with contrast dye to visualize spinal cord compression
These imaging tests will show the compression of the spinal cord, how much of the spine is involved, and the nature of the compressing tissue. This information guides your personalized treatment plan.
Treatment
Treatment depends on the cause of your myelopathy, the severity of your symptoms, and the rate at which the condition is progressing.
Conservative Management
Nonsurgical approaches may be considered to treat myelopathy. However, this is highly variable and dependent on the cause of myelopathy. Conservative options may include physical therapy, medications to manage pain and inflammation, and activity modifications.
Structural pressure on the spine or failed attempts at conservative treatments typically will lead to surgery.
Surgical Options
Surgery aims to relieve pressure on the spinal cord and prevent permanent nerve damage. Some surgical options include:
- Diskectomy: Removal of the portion of the disc causing pressure to the spinal cord. This procedure eliminates the source of compression while preserving surrounding structures.
- Laminectomy: Removal of part of the vertebra called the lamina. This posterior approach creates more space for the spinal cord and effectively decompresses the spinal canal.
- Cervical Fusion: Insertion of screws and a plate to stabilize the spine and prevent pressure on the spinal cord. This prevents abnormal motion while the vertebrae heal together.
The specific surgical technique depends on the location of the compression, the number of spinal levels affected, and the nature of the tissue causing the pressure.