Cervical Myelopathy and Spinal Cord Compression
Myelopathy occurs when the spinal cord is compressed. Spinal cord compression can cause neurologic symptoms—such as pain, numbness, or difficulty walking. Your spinal cord is the conduit that enables communication between your brain and body. The spinal cord begins at the base of the brain and ends at the first lumbar vertebra (L1). Below L1, the spinal cord becomes the cauda equina; a bundle of lumbar and sacral nerves.
- More common in adults age 50 and older
- Most often affects the cervical spine (neck)
- Less common in the thoracic spine (mid back)
- Sometimes affects the low back (eg, severe lumbar spinal stenosis)
- Usually a gradual and progressive disorder
- Can develop quickly (eg, trauma, injury)
Below is a lateral MRI of a patient's cervical spine. The red arrow points to areas where the spinal cord is compressed—cervical myelopathy.
Some of the symptoms of a myelopathy mimic other spinal problems. Symptoms that may be associated with cervical myelopathy include:
- Neck pain and stiffness
- Find yourself dropping things
- Hand clumsiness (eg, buttoning a shirt)
- Balance problems
- Difficulty walking
There are many different causes of myelopathy; several are listed below.
- Cervical kyphosis
- Cyst or tumor
- Degenerative spondylosis (spinal arthritis)
- Epidural abscess, infection
- Herniated disc
- Inflammatory diseases (eg, Rheumatoid Arthritis)
- Osteophytes (bone spurs)
- Spinal Stenosis
- Vertebral body abnormality
In addition to a thorough medical history and physical examination, a neurological exam is performed. The neurological exam is non-invasive and evaluates your sensory and motor functions. Sensory functions are related to your senses, such as sight, hearing, eye movement, and touch. Motor functions are related to your gait (how you walk), balance, coordination, reflexes, range of motion, and muscle movement.
If it is necessary, the doctor orders a x-ray, CT scan or MRI with or without myelography to be performed. The results of the imaging study are carefully analyzed and compared to your medical history, symptoms, and the outcome of the physical and neurological examinations. Together, the exam and test results may reveal the cause of your symptoms—helping your doctor confirm his diagnosis.
Your spine specialist may recommend spine surgery. The goals of spine surgery to treat myelopathy are: (1) remove pressure from the spinal cord, (2) prevent symptoms from becoming worse, and (3) improve your condition.
The type of surgery that may be recommended is called spinal decompression, which means removing (or reducing) pressure from the spinal cord. Depending on the cause of the myelography, surgery may involve removing a herniated disc or bone spurs (osteophytes) to decompress the cord. Spine surgery to treat a myelopathy may include other procedures, such as laminectomy and fusion. It may be necessary to implant instrumentation (eg, plate, screws, rods) to stabilize the spine.