What is Cervical Myelopathy?
Cervical myelopathy is a disorder that describes progressive dysfunction of the cervical (neck region) spinal cord. While myelopathy can affect the thoracic spine cord as well, this is much more rare. While many different conditions can lead to cervical myelopathy, the most common cause is cervical spondylotic myelopathy (CSM). This is cervical myelopathy caused by spondylosis or aging related changes in the cervical spine which leads of narrowing of the space available for the spinal cord and can cause spinal cord dysfunction.
Cervical Myelopathy Symptoms
The symptoms of cervical myelopathy include:
Loss of balance and coordination when walking
Difficulty with fine motor tasks such as buttoning buttons, placing jewelry, handling change, tying shoelaces
Tingling sensation and numbness in the arms or legs
Cervical Myelopathy Diagnosis
The diagnosis of cervical myelopathy begins with a thorough history and physical examination by a spine surgeon. This involves a detailed description of how long the symptoms have been present, and how quickly they have progressed. It is important to note if there has been progressive use of assistive devices. For example, a patient who used to walk unassisted, who then progressed to walking with a cane, and then progressed to requiring a walker has symptoms that are concerning for progressive myelopathy. Progressive difficulty with hand dexterity is also concerning for cervical myelopathy. The physical exam focuses on testing the function of the spinal cord by examining the patient’s balance, testing the strength and sensation in the arms and legs, and testing reflexes. Patients with myelopathy often have “jumpy” reflexes or even the presence of pathologic reflexes which shouldn’t be present. There may be atrophy of the small muscles of the hands which can be a sign of cervical myelopathy.
If cervical myelopathy is suspected, the diagnostic workup includes x-rays, MRI, and potentially also a CT scan of the cervical spine. EMG / nerve conduction studies are also sometimes obtained to rule out peripheral nerve disorders such as carpal tunnel syndrome or cubital tunnel syndrome.
Cervical Myelopathy Treatment Options
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.
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.