Cervical Disorders

Cervical Myelopathy

What is cervical myelopathy?

Cervical myelopathy describes a collection of symptoms that results from compression of the spinal cord in the cervical spine. Cord compression is often caused by age-related degeneration, but can also be due to a traumatic injury.  When the spinal cord is compressed, it causes neurologic dysfunction that results in certain patient symptoms and specific signs on a neurological examination.

Myelopathy is classified as mild, moderate or severe according to the degree of compression of the cervical cord as seen on MRI scan, the neurological examination and patient symptoms. Your surgeon will determine the degree of myelopathy.

Symptoms of Myelopathy

When the spinal cord is compressed, it may cause loss of function and/or loss of sensation at or below the site of compression.  Symptoms that commonly occur include:

• Tingling and/or numbness in your hands

• Difficulty with fine motor skills, such as buttoning a shirt or opening a necklace clasp

• Weakness of your arms and/or legs

• Trouble walking

• Balance difficulties

• Problems with controlling your bladder and/or bowels (occurs in late-stage myelopathy)

Typically, symptoms start without an obvious injury and slowly progress over time, usually months.  However, there are cases in which myelopathy may progress quickly or may occur after an injury, such as a fall.

Pain: Generally speaking, pain is not a specific symptom of myelopathy. Neck pain is often due to arthritic changes in the neck involving muscles, joints, ligaments and/or discs.

Neuropathic pain.  This is a different type of pain symptom that is uncommon, but can occur with myelopathy. Descriptions of neuropathic pain can be burning pain, an unpleasant tingling, sensitivity to light touch or “tight” sensations in the arms, hands and/or legs.

Causes

Common causes of myelopathy are cervical disc herniation, severe spinal stenosis, or trauma such as a serious fall or accident.

Diagnosis

If you are concerned about your symptoms, you should make an appointment to see a Healthcare Professional (HCP). They will perform a neurological examination which includes testing your muscle strength and reflexes, checking sensation of your arms and legs, observing your walking pattern and checking your balance. Depending on your examination, your HCP will order some tests.  

• MRI of the cervical spine. This is a specialized scan of your spinal cord and is important for diagnosing cervical myelopathy.  It is the best test to see if the spinal cord is compressed. Tell your HCP if you are claustrophobic as you may require a prescribed medication to be taken just before the scan.

•  Electromyogram (EMG) & nerve conduction study (NCS).   This is an electrical test that measures how your muscles and nerves are working.  It is an important test that will give your HCP information as to whether your symptoms are due to a problem with a nerve(s) and/or pressure on the spinal cord.

You may be referred to a neurosurgeon who will review the test results.  If you are diagnosed with cervical myelopathy, surgery may be recommended.

Treatment

Treatment for cervical myelopathy can be surgical or non-surgical, depending on the severity of the myelopathy and the degree of spinal cord compression.  The goal of surgical treatment is to remove pressure (or decompress) the spinal cord.  There are two different surgical approaches, either anterior cervical discectomy (with either fusion or insertion of artificial disc) or posterior cervical laminectomy and fusion.  Your surgeon will determine the right surgical procedure for you depending on the MRI scan and how your spinal cord is being compressed, whether from in front (from a disc) or behind the spinal cord (from degenerative changes).

If your myelopathy is mild, non-surgical treatments may be recommended.

Left untreated, myelopathy can worsen over time. Spinal cord compression can permanently damage the nerves that control motor and sensory functions, resulting in symptoms that are irreversible.  It is important to get care as soon as you notice symptoms, as early diagnosis and treatment can help improve your condition.