Myelopathy

Myelopathy is a serious condition that happens when your spinal cord becomes compressed or squeezed. This compression can disrupt the nerve signals traveling between your brain and body, leading to a range of symptoms. It often develops gradually and can affect your movement, sensation, and bladder or bowel function. Early diagnosis and treatment are important to prevent further damage.

What is Myelopathy?

Myelopathy is a condition caused by compression of the spinal cord, which is the main pathway for nerve signals between your brain and the rest of your body. This compression can disrupt these vital signals, leading to various symptoms depending on where the spinal cord is squeezed. It is a serious condition that often requires medical attention to prevent worsening damage.

Your spinal cord is a delicate bundle of nerves that runs from your brainstem down your back, protected by your spinal column (backbone). It acts like a superhighway, carrying messages that control movement, sensation, and organ function. When something presses on this cord, it can interfere with these messages. Myelopathy can occur in different parts of the spine. Cervical myelopathy affects the neck area, thoracic myelopathy affects the mid-back, and lumbar myelopathy affects the lower back. Lumbar myelopathy is less common because the spinal cord typically ends higher in the back, but compression of the nerve roots in this area can still cause similar symptoms. This compression can lead to a variety of problems, including weakness, numbness, and difficulty with balance. Understanding the specific location of the compression helps doctors determine the best course of treatment. The goal of treatment is to relieve the pressure on the spinal cord and prevent further neurological damage.

Symptoms

Symptoms of myelopathy often develop slowly over time and can vary depending on the location and severity of the spinal cord compression. Common signs include weakness, numbness, or tingling in the arms, hands, legs, or feet. You might also experience problems with balance, coordination, and fine motor skills, such as buttoning a shirt.

If the compression is in your neck (cervical myelopathy), you might notice pain or stiffness in your neck. You could also experience weakness, numbness, or tingling in your arms and hands. Difficulty with tasks requiring fine motor skills, like writing or picking up small objects, is a common sign. When myelopathy affects the mid-back (thoracic myelopathy), symptoms might include weakness or numbness in your legs and torso. You may also feel pain in your mid-back or experience difficulty walking. Balance problems are also common, making you feel unsteady on your feet. In more severe cases, or if the compression is significant, myelopathy can lead to more serious issues. These include problems with bladder or bowel control, such as urgency or incontinence. Any new or worsening neurological symptoms, especially those affecting balance or bladder/bowel function, warrant prompt medical evaluation.

Causes & risk factors

Myelopathy is most commonly caused by conditions that narrow the spinal canal, leading to spinal cord compression. Degenerative changes in the spine, such as osteoarthritis and disc herniation, are frequent culprits. Other causes include tumors, infections, trauma, and certain autoimmune diseases that affect the spine.

One of the most common causes is spinal stenosis, which is a narrowing of the spinal canal. This narrowing can be due to age-related wear and tear, such as the development of bone spurs (osteophytes) or thickening of ligaments. As people age, the discs between their vertebrae can also degenerate, bulge, or herniate, pressing on the spinal cord. Other conditions that can lead to myelopathy include rheumatoid arthritis, which can cause instability in the neck. Tumors, both cancerous and non-cancerous, can grow within or near the spinal cord, causing compression. Infections, such as abscesses, or inflammation can also put pressure on the spinal cord. Traumatic injuries, like those from car accidents or falls, can directly damage the spinal cord or cause fractures that lead to compression. Certain congenital conditions (present from birth) that affect the structure of the spine can also increase the risk. While age is a significant risk factor due to degenerative changes, myelopathy can affect people of any age depending on the underlying cause.

How it's diagnosed

Diagnosing myelopathy involves a thorough physical and neurological examination, where a doctor assesses your reflexes, strength, sensation, and balance. Imaging tests are crucial to visualize the spinal cord and identify the cause and location of compression. These tests typically include magnetic resonance imaging (MRI), computed tomography (CT) scans, and X-rays.

During the neurological exam, your doctor will check your reflexes, muscle strength, and ability to feel sensations in different parts of your body. They will also observe your gait (how you walk) and test your balance and coordination. These assessments help pinpoint which areas of the spinal cord might be affected. Imaging tests provide detailed pictures of your spine. An MRI is often the preferred test because it can clearly show the spinal cord, nerves, discs, and any soft tissue abnormalities that might be causing compression. A CT scan can provide more detail about bone structures, and X-rays can show alignment issues or bone spurs. Sometimes, electrophysiological studies, such as electromyography (EMG) and nerve conduction studies (NCS), are used. These tests measure the electrical activity of your muscles and nerves. They can help determine if nerve damage is present and distinguish myelopathy from other conditions that might cause similar symptoms, such as peripheral neuropathy.

Treatment options

Treatment for myelopathy typically focuses on relieving the pressure on the spinal cord to prevent further damage and improve symptoms. For many people, surgery is the most effective option to achieve this decompression. Conservative treatments, such as physical therapy and medication, may be used for milder cases or to manage symptoms before or after surgery.

The primary goal of treatment is to decompress the spinal cord. This means removing whatever is pressing on it. For many people with myelopathy, especially if symptoms are progressing, surgery is often recommended. Surgical procedures aim to create more space around the spinal cord. Common surgical techniques include laminectomy, where a part of the bone (lamina) covering the spinal cord is removed. Discectomy involves removing a damaged disc. Spinal fusion may also be performed after decompression to stabilize the spine. The specific type of surgery depends on the location and cause of the compression. For very mild cases or when surgery is not immediately necessary, conservative treatments may be tried. These can include physical therapy to improve strength, flexibility, and balance. Medications, such as pain relievers, muscle relaxants, or anti-inflammatory drugs, can help manage symptoms. Bracing might also be used to support the spine, but these treatments usually do not resolve the underlying compression.

Recovery & outlook

The recovery and outlook for myelopathy vary greatly among individuals, depending on factors like the severity and duration of the compression before treatment. Early diagnosis and intervention, especially surgery, generally lead to better outcomes and can often stop the progression of symptoms. Rehabilitation is a crucial part of the recovery process.

After surgery, many people experience improvement in their symptoms, such as reduced pain, improved strength, and better balance. However, some neurological deficits, especially those present for a long time before treatment, may not fully resolve. The spinal cord can be permanently damaged if compression is severe or prolonged. Rehabilitation, often involving physical therapy and occupational therapy, is vital for recovery. These therapies help you regain strength, improve coordination, and learn strategies to manage any remaining limitations. A physical therapist can guide you through exercises to strengthen muscles and improve your gait. While surgery can prevent further damage, it does not guarantee a complete return to pre-myelopathy function. Regular follow-up with your healthcare team is important to monitor your progress and address any new concerns. Maintaining a healthy lifestyle and adhering to rehabilitation plans can significantly contribute to a better long-term outlook.

When to see a doctor

You should see a doctor promptly if you experience new or worsening symptoms that suggest spinal cord compression. These include progressive weakness, numbness, or tingling in your limbs, difficulty with balance or walking, or problems with fine motor skills. Sudden changes in bladder or bowel control are particularly urgent and require immediate medical attention.

Do not delay seeking medical care if you notice any of these signs. Early diagnosis and treatment are crucial for preventing irreversible damage to the spinal cord. If you have a known spinal condition, such as severe arthritis or a herniated disc, be especially vigilant for new neurological symptoms. Specific red-flag symptoms that warrant immediate medical evaluation include sudden, severe neck or back pain accompanied by weakness or numbness. Any rapid decline in your ability to walk or control your movements is also a serious concern. Loss of bladder or bowel control, often called cauda equina syndrome if it affects the lower spinal nerves, is a medical emergency. Even if symptoms are mild and develop slowly, it is important to discuss them with your doctor. They can determine if your symptoms are related to myelopathy or another condition and recommend the appropriate diagnostic tests and treatment plan.

Frequently asked questions

Is myelopathy a serious condition?

Yes, myelopathy is considered a serious condition because it involves compression of the spinal cord, which can lead to permanent neurological damage if left untreated. It can significantly affect your ability to move, feel, and control bodily functions. Early diagnosis and treatment are crucial to prevent further progression and improve outcomes.

Can myelopathy be cured?

Myelopathy can often be effectively treated, especially with surgery to relieve spinal cord compression. While treatment can stop the progression of the condition and improve many symptoms, some neurological deficits, particularly if they were present for a long time, may not fully resolve. The goal is to prevent further damage and maximize recovery.

What is the difference between myelopathy and radiculopathy?

Myelopathy refers to symptoms caused by compression of the spinal cord itself, affecting the main nerve pathway. Radiculopathy, on the other hand, is caused by compression or irritation of a single nerve root as it exits the spinal cord. Myelopathy typically affects a broader range of functions (e.g., balance, fine motor skills, bladder control), while radiculopathy often causes pain, numbness, or weakness in a specific area supplied by that single nerve (e.g., sciatica).

How long does it take to recover from myelopathy surgery?

Recovery time after myelopathy surgery varies widely depending on the individual, the severity of the condition before surgery, and the type of surgery performed. Some people may see rapid improvement, while others require several months of rehabilitation. Physical therapy is often a key part of recovery to regain strength and function. Your doctor will provide a personalized recovery timeline.

Can myelopathy come back after treatment?

While surgery can effectively decompress the spinal cord and prevent further damage from the original cause, myelopathy can potentially recur or develop in a different part of the spine due to ongoing degenerative changes. Regular follow-up with your doctor is important to monitor your spinal health and address any new symptoms promptly.

Are there non-surgical treatments for myelopathy?

For very mild cases of myelopathy, or if surgery is not an option, non-surgical treatments like physical therapy, medication for pain and inflammation, and bracing may be used to manage symptoms. However, these conservative approaches typically do not relieve the underlying spinal cord compression and are generally not considered definitive treatment for progressive myelopathy. Surgery is often necessary to prevent further neurological decline.

Sources

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