Cervical Myelopathy

Myelopathy is a term used to refer to diseases that affect the spinal cord. Cervical spondylotic myelopathy (CSM) is the most common disorder and it typically occurs in individuals aged above 55 years. The gradual wear and tear because of aging causes narrowing of the spinal canal that leads to compression of the spinal cord. This may cause symptoms such as:

  • Loss of balance and coordination – difficulty in walking and performing simple tasks
  • Difficulty in buttoning buttons, handling change, tying shoelaces
  • Tingling sensation and numbness
  • Weakness

Diagnosis

Your doctor may ask about your symptoms and examine your neck to look for any abnormal reflexes, numbness and atrophy of muscles. Some of the diagnostic tests such as X-rays, magnetic resonance imaging and myelogram may be done to confirm the diagnosis. Myelogram is a special type of computed tomography (CT) scan in which a dye is injected prior to the scan in order to get a clearer outline of the spinal cord.

Treatment Options

Nonsurgical Treatment

In patients that are symptomatic from compression of the cervical spinal cord, nonsurgical treatments are NOT indicated. The only way to relieve the pressure on the spinal cord and stop progressive neurologic dysfunction is to decompress the spinal cord with surgery.

In patients with asymptomatic cervical spinal cord compression or spinal stenosis, or with extremely mild symptoms careful observation can be performed. Nonsurgical treatments in these cases include:

  • Physical therapy : Simple exercises help to improve patients balance and general conditioning, including the strength in their arms and legs.
  • Nonsteroidal anti-inflammatory drugs (NSAIDs) : Medications such as ibuprofen or naproxen can be taken to reduce neck pain.

Surgical Treatment

Decompression of the cervical spinal cord should be performed in any patient with cervical myelopathy or symptoms from spinal cord compression. This can be done via an anterior approach, posterior approach, or sometimes both. During the procedure, certain plates, screws, and rods may be inserted to give internal support to the cervical spine and promote healing of the bone graft.