What is Cervical Myelopathy?

Cervical myelopathy is a condition caused by compression of the spinal cord in the neck (cervical spine), leading to progressive nerve dysfunction. This occurs when the spinal cord is squeezed due to degenerative changes, herniated discs, bone spurs, or other structural abnormalities in the cervical spine. As the condition worsens, it can affect movement, sensation, and even bladder and bowel control.

Types of Cervical Myelopathy:

Cervical myelopathy can be classified based on the underlying cause:

• Degenerative Cervical Myelopathy (DCM): The most common form, caused by age-related wear and tear on the spine, leading to disc degeneration, bone spurs, and ligament thickening.
• Congenital Cervical Myelopathy: Some individuals are born with a narrow spinal canal (congenital spinal stenosis) and may develop symptoms earlier in life.
• Post-Traumatic Myelopathy: Spinal cord compression resulting from a previous injury or fracture.
• Inflammatory or Autoimmune Myelopathy: Conditions like rheumatoid arthritis can cause inflammation that narrows the spinal canal.
• Tumor-Related Myelopathy: Tumors pressing on the spinal cord can lead to symptoms.

Causes

Cervical myelopathy occurs when progressive narrowing of the spinal canal (cervical stenosis) compresses the spinal cord. Common causes include:

• Degenerative Disc Disease (DDD): The natural aging process leads to disc wear and loss of spinal cushioning.
• Osteoarthritis & Bone Spurs (Spondylosis): Arthritis causes bony growths (osteophytes) that encroach on the spinal canal.
• Herniated Discs: Bulging or ruptured discs press on the spinal cord.
• Thickened Ligaments (Ligamentum Flavum Hypertrophy): Over time, spinal ligaments become stiff and thickened, compressing the spinal cord.
• Trauma or Fractures: Past injuries or fractures can misalign the spine, reducing space for the spinal cord.
• Spinal Tumors or Cysts: Abnormal growths in the spinal canal exert pressure on the spinal cord.

Risk Factors

• Age >50: Degenerative changes become more common with age.
• History of Neck Injury: Prior trauma increases the risk of spinal cord compression.
• Genetic Predisposition: Family history of spinal stenosis or arthritis.
• Occupational Strain: Jobs involving repetitive neck motion, heavy lifting, or prolonged posture (e.g., desk jobs, construction work).
• Smoking & Poor Lifestyle: Smoking accelerates disc degeneration, and a sedentary lifestyle weakens spinal support muscles.
• Autoimmune Disorders: Conditions like rheumatoid arthritis can contribute to cervical myelopathy.

Symptoms

Symptoms of cervical myelopathy worsen over time and may be subtle at first.

Common Symptoms:

• Neck stiffness and pain
• Numbness or tingling in the hands, arms, or fingers
• Loss of hand coordination and fine motor skills (e.g., difficulty buttoning shirts, writing)
• Weakness in the arms and legs
• Difficulty walking, frequent tripping, or imbalance
• Heavy or clumsy feeling in the legs

Less Common Symptoms:

• Loss of bladder or bowel control (in severe cases)
• Electric shock-like sensations down the spine when bending the neck (Lhermitte’s sign)
• Muscle spasms or cramps in the arms and legs
• Difficulty swallowing or hoarseness (if compression affects certain spinal levels)

Diagnosis

How is Cervical Myelopathy Diagnosed?

A thorough evaluation of symptoms and performance of a neurological exam to assess reflexes, muscle strength, coordination, and sensation.

Diagnostic Tests:

• MRI (Magnetic Resonance Imaging): The best test for detecting spinal cord compression, herniated discs, and soft tissue abnormalities.
• CT Scan (Computed Tomography): Useful for evaluating bone spurs and fractures.
• X-rays: Show spinal alignment, disc space narrowing, and arthritis-related changes.
• Electromyography (EMG) & Nerve Conduction Studies (NCS): Assess nerve function and differentiate myelopathy from other nerve disorders.
• Myelogram: A specialized CT scan with contrast dye to highlight spinal cord compression.

Treatment Strategies

Treatment depends on the severity of symptoms and whether the spinal cord is at risk of permanent damage.

Non-Surgical Treatment may include:

• Physical Therapy (PT): Strengthens neck and core muscles, improves balance, and reduces stiffness.
• Pain Management:
  • Anti-inflammatory medications (NSAIDs): Reduce pain and inflammation.
  • Muscle relaxants: Help with spasms.
  • Epidural steroid injections: Provide temporary relief by reducing swelling around the spinal cord.
• Neck Bracing: In some cases, a soft cervical collar may provide temporary support.
• Lifestyle Modifications: Avoiding activities that worsen symptoms, improving posture, and using ergonomic tools.

Surgical Treatment:

Surgery is often recommended if symptoms worsen, mobility is impaired, or there is risk of permanent nerve damage. The goal is to decompress the spinal cord and stabilize the spine.

Types of Surgery:

• Anterior Cervical Discectomy and Fusion (ACDF): Removal of a damaged disc, followed by fusion of the affected vertebrae.
• Laminectomy: Removal of part of the vertebra (lamina) to create more space for the spinal cord.
• Laminoplasty: Reshaping and expanding the spinal canal while preserving motion.
• Posterior Cervical Fusion: Used in cases requiring extensive stabilization with screws and rods.

When is Surgery Indicated?

• Severe or progressive symptoms (e.g., worsening weakness, difficulty walking, loss of bladder control).
• Significant spinal cord compression on imaging.
• Non-surgical treatments fail to provide relief.

Prognosis

With Treatment:

• Early intervention improves outcomes, with many patients regaining function and mobility.
• Surgical intervention aims to stabilize or improve symptoms.
• Physical therapy post-surgery enhances recovery and prevents further complications.

Without Treatment:

• Symptoms may worsen progressively, leading to permanent nerve damage.
• Loss of mobility and difficulty performing daily activities.
• In severe cases, paralysis or severe disability may occur.

Long-Term Considerations & Monitoring

• Regular Neurological Evaluations: To monitor symptoms and prevent complications.
• Rehabilitation & Exercise: Strengthening exercises to maintain spinal stability.
• Posture & Ergonomic Adjustments: Proper workstation setup and avoiding prolonged neck strain.
• Weight Management & Healthy Lifestyle: Reducing strain on the spine and preventing further degeneration.

Living with Cervical Myelopathy

Cervical myelopathy is a progressive but manageable condition. Early diagnosis and timely treatment can significantly improve quality of life and prevent severe disability. If you experience symptoms such as numbness, weakness, or difficulty walking, contact us for an evaluation and to determine the best course of action.