Cervical myelopathy is a serious condition affecting the cervical spine, and if left untreated it can lead to significant and permanent nerve damage including paralysis and death. In most cases, this is an urgent surgical condition.
Myelopathy describes any neurologic symptoms related to dysfunction of the spinal cord. Cervical myelopathy is frequently caused by compression of the spinal cord in the neck (cervical spine) due to stenosis (narrowing of the spinal canal in the neck) that creates pressure on the spinal cord. Cervical spinal stenosis most often develops due to degenerative changes in the spine, such as with osteoarthritis or degeneration. A large, acute disc herniation or an unstable fracture compressing the spinal cord may also cause myelopathy.
Causes of Cervical Myelopathy
Anything that reduces the space around your spinal cord can cause myelopathy, such as
- The normal wear and tear of everyday life.
- An Injury to your neck (spinal trauma).
- A disease, such as arthritis.
- A tumor.
Any condition that can cause stenosis may cause myelopathy. Myelopathy is a very serious condition.
Symptoms of Cervical Myelopathy
Myelopathy actually has a wide range of symptoms, often depending on where the compression happens along your spinal cord. When affecting the cervical spine, you may experience pain, numbness, weakness, or tingling, and have problems such as
- Difficulty with Walking
- Weakness in the Lower Extremities
- Loss of Balance
- Loss of Coordination in the Arms, Hands, or Legs
- Dexterity Problems
- Handwriting Deterioration
- Loss of Fine Motor Skills (e.g., picking up coins, buttoning shirts)
Exaggerated reflexes may also occur, resulting in the compromised smooth function of muscles in the arms or legs.
Diagnosing Cervical Myelopathy
During your consultation, Dr. Ball will conduct a physical exam and measure your muscle strength and reflexes. He may also
- Order imaging tests, including an MRI scan, an X-ray, or a CT myelogram of your neck.
- Conduct electrical tests to measure how well the nerves in your arms and hand communicate with your brain through the spinal cord.
An MRI scan is the most conclusive test for diagnosing myelopathy, as the pressure on the spinal cord may cause nerve cell death and changes in the appearance of the spinal cord on MRI studies.
Cervical Myelopathy Treatment
Surgical Treatment for Cervical Myelopathy
If a closely monitored period of nonsurgical treatment does not alleviate cervical myelopathy symptoms, surgery may be recommended.
Since myelopathy is considered a progressive disease resulting in irreversible damage of the spinal cord, it is considered a surgical disorder. Failure to properly treat this condition may result in paralysis and loss of function in both arms and both legs, also known as quadriplegia. Severe myelopathy may thus be treated with a cervical laminoplasty or laminectomy with or without fusion. During a laminoplasty, Dr. Ball creates more space for the spinal cord and nerve roots to relieve the painful pressure of spinal stenosis, a narrowing of the spinal canal that can result from arthritis.
On occasion, the complete removal of the vertebral body, or corpectomy, in conjunction with fusion is a necessary part of the decompression to relieve pressure on the spinal cord and the spinal nerves. It involves the removal of bone and discs from your cervical spine, followed by a fusion using a bone graft or implant (cage) to stabilize the spine.
Surgery can take 1-2 hours, and sometimes 3 or more depending on how many discs will be removed, how badly the discs or vertebrae are diseased, and other factors. During your consultation, Dr. Ball will discuss these details with you.
Recovery from Cervical Myelopathy Surgery
After surgery, you can expect your neck to feel stiff or sore. You may also find it difficult to sit or stand in one position for very long and you may need pain medicine.
If you have a cervical fusion, you will be given a neck brace to wear after surgery. Dr. Ball will let you know how long you will need to wear it.
Typically, it may take patients up to 4 to 6 weeks to recover and get back to normal activities, but it may take 3 to 6 months for a full recovery.