Cervical Myelopathy

Cervical myelopathy is a serious condition where the spinal cord in your neck (cervical spine) becomes compressed, often due to age-related changes. This compression can lead to a range of symptoms, including weakness, numbness, balance problems, and difficulty with fine motor skills. Early diagnosis and treatment are important to prevent symptoms from worsening and to improve your quality of life.

What is Cervical Myelopathy?

Cervical myelopathy is a condition where the spinal cord in your neck (cervical spine) is squeezed or compressed. This compression disrupts the normal signals traveling through the spinal cord, leading to various neurological symptoms. It is the most common cause of spinal cord dysfunction in adults, often developing slowly over time.

Your spinal cord is a vital bundle of nerves that runs from your brain down your back, carrying messages between your brain and the rest of your body. In cervical myelopathy, this crucial pathway is narrowed in the neck area. This narrowing can put pressure on the spinal cord itself. When the spinal cord is compressed, it cannot properly send or receive signals. This disruption can affect different parts of your body, leading to problems with movement, sensation, and balance. The condition usually worsens gradually, so early recognition and treatment are important to help manage symptoms and prevent further damage.

Symptoms

Symptoms of cervical myelopathy often develop slowly and can vary, but commonly include numbness, tingling, or weakness in your arms, hands, legs, or feet. You might also notice problems with balance, coordination, and fine motor skills, such as difficulty writing or buttoning clothes. Neck pain or stiffness may or may not be present.

Many people with cervical myelopathy first notice changes in their hands. You might find it harder to perform everyday tasks that require precise hand movements, like writing, picking up small objects, or fastening buttons. This is often described as a loss of fine motor skills. Weakness, numbness, or a “pins and needles” sensation (paresthesia) can also affect your arms, hands, legs, and feet. You may feel clumsy or unsteady on your feet, leading to balance problems and a tendency to stumble. Walking can become more difficult, sometimes described as a “spastic gait” where your legs feel stiff or heavy. In some cases, reflexes in your arms and legs may become overactive (hyperreflexia). While neck pain and stiffness can occur, they are not always the main symptoms of cervical myelopathy. In more advanced or severe cases, some individuals may experience a loss of bladder or bowel control, which requires immediate medical attention.

Causes & risk factors

Cervical myelopathy is most often caused by age-related wear and tear on the spine, leading to conditions like bone spurs or herniated discs that compress the spinal cord. Other risk factors include spinal injuries, tumors, infections, or inflammatory diseases. A naturally narrow spinal canal can also increase your risk.

The most common cause of cervical myelopathy is the natural aging process, which leads to degenerative changes in the spine. Over time, the discs between your vertebrae (the bones of your spine) can bulge or herniate, pushing into the spinal canal. Bone spurs (osteophytes) can also form on the vertebrae, further narrowing the space around the spinal cord. Ligaments in the spine can also thicken and harden, contributing to this compression. This narrowing of the spinal canal is called spinal stenosis. It can be thought of like a tunnel getting smaller, squeezing the important cables (your spinal cord) inside. While aging is the primary driver, other factors can also contribute. These include previous neck injuries, which can lead to instability or scar tissue that compresses the cord. Less common causes include tumors growing within or near the spinal cord, infections that cause swelling, or inflammatory diseases like rheumatoid arthritis that affect the spine. Some people are also born with a spinal canal that is naturally narrower than average, making them more susceptible to myelopathy even with minor degenerative changes.

How it's diagnosed

Diagnosing cervical myelopathy involves a physical exam to check your reflexes, strength, and sensation, along with imaging tests. Magnetic resonance imaging (MRI) is usually the best test to clearly show the spinal cord and any compression. Other tests like X-rays or CT scans may also be used to examine the bones.

When you see a doctor for symptoms that suggest cervical myelopathy, they will typically start with a thorough physical and neurological examination. During this exam, the doctor will assess your muscle strength, test your reflexes, check your sensation in different areas of your body, and observe your gait (how you walk) and balance. These assessments help identify signs of spinal cord compression. Imaging tests are crucial for confirming the diagnosis and pinpointing the exact location and cause of the compression. An MRI (magnetic resonance imaging) scan is often the preferred imaging method because it provides detailed images of the spinal cord, nerve roots, and surrounding soft tissues, clearly showing any areas of compression. Other imaging tests may also be used. X-rays can show the alignment of your spine and identify bone spurs or signs of arthritis. A CT (computed tomography) scan provides more detailed images of the bones than X-rays and can be helpful for surgical planning. Sometimes, electromyography (EMG) and nerve conduction studies are performed to rule out other conditions that affect nerves, such as peripheral neuropathy.

Treatment options

Treatment for cervical myelopathy primarily focuses on relieving pressure on the spinal cord to prevent symptoms from worsening. While non-surgical options like physical therapy or pain medication may help manage some symptoms, surgical decompression is generally the main treatment recommended to directly address the compression and improve neurological function.

For most people with cervical myelopathy, especially if symptoms are progressing, surgical decompression is the recommended treatment. The goal of surgery is to remove the source of pressure on the spinal cord, whether it's a herniated disc, bone spurs, or thickened ligaments. This can help prevent further damage and may improve existing symptoms. There are several surgical approaches, and the best option depends on the specific location and extent of the compression. Common procedures include anterior cervical discectomy and fusion (ACDF), where a disc is removed and the vertebrae are fused, or laminectomy and laminoplasty, which involve removing or reshaping parts of the bone at the back of the vertebrae to create more space for the spinal cord. Non-surgical treatments, such as physical therapy, neck braces (used short-term), or pain medications (like nonsteroidal anti-inflammatory drugs or NSAIDs), are generally not effective at reversing the spinal cord compression itself. They may be considered for individuals with very mild symptoms or those who are not candidates for surgery, primarily to manage pain and maintain function. However, low-certainty evidence suggests surgery may offer better neurological function and quality of life compared to non-surgical treatment, though more high-quality studies are needed.

Recovery & outlook

The recovery and outlook for cervical myelopathy depend on several factors, including how severe your symptoms were before treatment and how long they lasted. Surgery usually prevents symptoms from getting worse, and many people experience some improvement in their neurological function and quality of life. Early diagnosis and treatment generally lead to better outcomes.

After surgery for cervical myelopathy, recovery involves a period of healing and often includes physical therapy. The goal of physical therapy is to help you regain strength, flexibility, and balance, and to improve your ability to perform daily activities. Your doctor will provide specific instructions for activity restrictions and rehabilitation exercises. While surgery is generally effective at stopping the progression of symptoms, the extent of improvement varies. Some people experience significant relief from their symptoms, while others may have some lingering neurological deficits, such as mild weakness or numbness. The longer the spinal cord has been compressed and the more severe the symptoms before surgery, the less likely it is that all symptoms will fully resolve. It's important to have realistic expectations and to work closely with your healthcare team throughout your recovery. Regular follow-up appointments are necessary to monitor your progress and address any ongoing concerns. While there are risks associated with any surgery, the potential benefits of preventing further spinal cord damage often outweigh these risks for individuals with progressive cervical myelopathy.

When to see a doctor

You should see a doctor if you experience symptoms that could indicate cervical myelopathy, especially if they are new, worsening, or affecting your daily life. These include persistent numbness, tingling, weakness in your limbs, problems with balance or coordination, or difficulty with fine motor tasks like writing or buttoning clothes.

It is important to seek medical attention promptly if you notice any signs of spinal cord compression. Early diagnosis and treatment can significantly impact your long-term outcome. Do not wait for symptoms to become severe before seeking help. Specifically, contact your doctor if you develop new or worsening issues such as: * Weakness, numbness, or tingling in your arms, hands, legs, or feet. * Difficulty with fine motor skills, like struggling to write, button a shirt, or pick up small objects. * Problems with balance, clumsiness, or frequent stumbling. * Changes in your gait, making walking feel unsteady or stiff. * Any loss of bladder or bowel control, which is a more severe symptom and requires urgent medical evaluation. These symptoms could be signs of cervical myelopathy or another serious neurological condition. A healthcare professional can properly evaluate your symptoms, perform necessary diagnostic tests, and recommend the most appropriate course of action.

Frequently asked questions

Can cervical myelopathy be cured without surgery?

While non-surgical treatments like physical therapy or pain medication can help manage some symptoms, they generally do not reverse the spinal cord compression itself. Surgery is typically the main treatment recommended to relieve pressure on the spinal cord and prevent symptoms from worsening, especially if they are progressing.

How long does it take to recover from cervical myelopathy surgery?

Recovery time varies depending on the individual, the type of surgery, and the severity of symptoms before the procedure. It typically involves a period of healing followed by physical therapy, which can last several weeks to months. Your doctor will provide a personalized recovery plan.

Is cervical myelopathy always painful?

No, cervical myelopathy does not always cause significant neck pain. While some individuals may experience neck pain or stiffness, the primary symptoms often relate to neurological issues like numbness, weakness, balance problems, and difficulty with fine motor skills in the arms and legs.

Can physical therapy help cervical myelopathy?

Physical therapy can be beneficial for managing some symptoms, such as improving strength, flexibility, and balance, and can be part of a post-surgical rehabilitation plan. However, physical therapy alone usually cannot relieve the direct compression on the spinal cord that causes cervical myelopathy.

What is the difference between cervical myelopathy and cervical radiculopathy?

Cervical myelopathy is compression of the spinal cord, affecting multiple nerve pathways and often causing symptoms in both arms and legs, plus balance issues. Cervical radiculopathy is compression of a single spinal nerve root, typically causing pain, numbness, or weakness in a specific area of one arm or hand.

Can cervical myelopathy come back after surgery?

Surgery aims to decompress the spinal cord at the affected levels. While the treated areas are usually stable, new areas of compression can sometimes develop over time due to ongoing degenerative changes in other parts of the cervical spine. Regular follow-ups with your doctor are important.

Sources

• MedlinePlus — Cervical Myelopathy
• Mayo Clinic — Cervical Myelopathy
• Cochrane Library — Cervical Myelopathy