Myelopathy is a medical condition that results from the spinal cord being compressed or damaged, causing various neurological symptoms. The spinal cord is a long and slender bundle of nerves that runs from the base of the brain down to the centre of the back. Several factors, such as degenerative changes in the spine, spinal cord injury, infection, or inflammation, can lead to myelopathy.
Cervical myelopathy is a condition characterised by damage or compression of the spinal cord in the cervical (neck) region.
Cervical Spondylotic myelopathy (CSM) occurs when degenerative changes in the spine cause the neck bones and discs to wear down, narrowing the spinal canal and compressing the spinal cord.
Cervical myelopathy can cause various symptoms, such as weakness, numbness, and tingling sensations in the arms and legs, problems with balance and coordination, and bladder or bowel dysfunction.
What causes Cervical Myelopathy?
Cervical myelopathy can be caused by various factors that lead to compression or damage to the spinal cord in the cervical (neck) region. The following are the causes:
- Cervical Spondylotic myelopathy (CSM): Most common and can occur due to ageing, wear and tear, or other factors. These changes can include the formation of bone spurs, herniated discs, or the thickening of ligaments that narrow the spinal canal and put pressure on the spinal cord.
- Ossified posterior longitudinal ligament: The posterior longitudinal ligament is a band of tissue that runs along the back of the vertebral bodies within the spinal column. This ligament helps to stabilize the spinal column and prevent excessive movement of the vertebrae. In some cases, the posterior longitudinal ligament may become ossified, meaning it undergoes a process of calcification and hardening. This can lead to the formation of bony spurs or a complete fusion of the ligament with the vertebral bodies, which can cause compression or damage to the spinal cord or nerve roots.
- Other causes of cervical myelopathy can include spinal cord injury, tumours, infections, or inflammation.
How does Cervical Spondylotic Myelopathy present?
Cervical spondylotic myelopathy (CSM) can present with a wide range of symptoms that can vary in severity and location depending on the degree of spinal cord compression and the affected level of the cervical spine. Some common symptoms of CSM include:
- Pain: Pain in the neck, shoulders, or arms may be a symptom of CSM, although it is not always present.
- Weakness: Muscle weakness in the arms, hands, or legs is a common symptom of CSM. The weakness may be subtle at first and may progress over time, making it difficult to perform everyday tasks such as holding objects, writing, or walking.
- Numbness and Tingling: CSM can cause numbness or tingling sensations in the hands, feet, or other body areas.
- Balance and Coordination Problems: Patients with CSM may have trouble with balance and coordination, making walking or performing other activities difficult.
- Bladder and Bowel Dysfunction: In severe cases, CSM can affect bladder and bowel function, causing incontinence or difficulty with urination and bowel movements.
Diagnosis of Cervical Myelopathy.
Diagnosing of Cervical Myelopathy typically involves a combination of a patient's medical history, physical examination, and imaging tests.
During the physical examination, the healthcare provider will perform a physical examination to assess the range of motion, reflexes, and strength of the limbs. They may also check for any numbness, tingling and walking to see for gait changes.
Imaging tests such as X-rays, MRI, and CT scans can help visualise the spine and identify any spinal canal narrowing or herniated discs that may be causing pressure on the spinal cord or nerves.
In some cases, further tests such as electromyography (EMG) or nerve conduction studies (NCS) may be required to evaluate nerve function and determine the extent of nerve damage or rule out other causes like non-compressive nerve pathology.
Treatment of Cervical Spondylotic Myelopathy
Treatment for cervical spondylotic myelopathy (CSM) depends on the severity of the condition and the specific symptoms experienced by the individual.
Cervical myelopathy is a serious problem. The pressure and damage to the spinal cord will not go away, and the symptoms would most likely worsen without surgery.
Treatment options may include:
- Non-surgical treatment may include physical therapy and medication for pain. This is reserved only for mild disease with no functional impairment.
- Surgery: Surgery is recommended for patients with symptoms that do not improve with non-surgical treatment or when there is significant spinal cord compression. Early recognition and treatment prior to spinal cord damage are critical for good clinical outcomes.
The type of surgery performed depends on the location and severity of the compression. Common surgical procedures for CSM include decompression surgery, which involves removing the part of the bone or disc that is compressing the spinal cord, and fusion surgery, which involves joining two or more vertebrae together to provide stability to the spine.
Following surgery, rehabilitation may be necessary to restore strength, mobility, and function. This may include physical therapy and occupational therapy.
Explore procedures for Cervical Disc Myelopathy:
Cervical Discectomy: A surgical procedure to remove the damaged disc to relieve spinal cord or nerve root pressure.
Cervical Laminectomy: Surgery to remove the back part of the vertebra, relieving pressure on the spinal cord.
Explore more related spinal conditions:
Lumbar Disc Prolapse: Learn about the displacement of lumbar discs and its effects on spinal health.
Cervical Disc Prolapse: Discover the nature of cervical disc displacement and its potential treatments.
Arm Pain (Cervical Radiculopathy): Understand the nerve compression in the cervical spine causing pain and numbness in the arms.