Cervical Myelopathy Treatment Options

Spinal cord compression can be caused by arthritis that narrows the spinal canal, gradual degeneration of the spine, and hardening of the ligaments surrounding the spinal cord.  The most common cause of cervical myelopathy is age-related degeneration of the discs, ligaments, and vertebrae of the cervical spine. Without treatment, many patients progress to paralysis and loss of function.

The treatment for cervical myelopathy depends on the severity of symptoms, the cause of the spinal cord compression, and the patient’s overall health. Treatment options can be categorized into non-surgical and surgical.

Non-surgical treatments are typically considered for mild cases of cervical myelopathy or when surgery poses too high a risk. These may include:

• Physical therapy: To strengthen muscles and improve flexibility and balance.
• Medications: Anti-inflammatory drugs can help manage pain and swelling.
• Activity modification: Avoiding activities that exacerbate symptoms.
• Pain management techniques include using pain relief medications, heat, or ice therapy.
• Epidural steroid injections

Who is a surgical candidate?

• Patients with neurological symptoms of weakness and numbness in the hands, arms, or legs.
• Patients whose fine motor skills are compromised.
• Patients with balance and gait issues.
• Patients with severe disabling pain.

The goal of surgery is surgical decompression by increasing the spinal canal space to provide a safe space for the spinal cord to function normally and reduce the risk of quadriplegia or paraplegia. Patients with moderate to severe cases involving multiple levels of disc disease should proceed to surgery when the neurological function is at risk. Younger patients with shorter symptoms tend to have the best outcomes. The benefit of operative intervention has been well established.

Common surgical procedures include:

1. Anterior cervical discectomy and fusion (ACDF): This procedure involves removing the disc(s), pressing on the spinal cord, and stabilizing the area with a graft and hardware.
2. Anterior cervical corpectomy and fusion: This procedure relieves pressure on the spinal cord and nerve roots in the cervical spine (neck). The corpectomy removes the damaged vertebrae. Then, the area is stabilized with a graft and hardware.
3. Microsurgical cervical laminoplasty: This procedure enlarges the spinal canal to relieve pressure on the spinal cord without removing the posterior elements of the vertebrae.
4. Cervical laminectomy: This involves removing a portion of the vertebra (lamina) to relieve pressure on the spinal cord. It may be combined with spinal fusion to stabilize the spine.

The choice of surgical procedure depends on various factors, including the location and extent of the spinal cord compression, the number of vertebrae involved, and the patient’s overall health and preferences.