Cervical Myelopathy
Cervical Myelopathy: Causes, Symptoms, Diagnosis, and Treatment
Cervical myelopathy refers to dysfunction of the cervical spinal cord caused by progressive compression. This condition results in various neurological symptoms and can significantly impact a patient’s quality of life. The most common cause is chronic cervical spondylosis, leading to gradual spinal cord compression due to factors such as progressive disc bulge, osteophyte formation, and ligamentum flavum hypertrophy. This condition is known as Spondylotic Cervical Myelopathy.
In some cases, individuals are predisposed to developing cervical myelopathy due to a congenitally narrow spinal canal, a condition termed Congenital Spinal Stenosis. Another common cause is ossification of spinal ligaments, particularly the posterior longitudinal ligament and ligamentum flavum, which can further reduce spinal canal space. Additionally, external factors such as spinal infections, fractures, or tumors may also exert pressure on the spinal cord, leading to symptoms of cervical myelopathy.
Symptoms of Cervical Myelopathy
Cervical myelopathy can affect the neurological function of both the upper and lower extremities, as well as the trunk below the level of compression. Symptoms may vary depending on the severity and progression of the condition. The most common symptoms include:
- Tingling, numbness, and weakness in the upper extremities
- Loss of grip strength and hand clumsiness, making tasks such as buttoning clothes difficult
- Loss of balance and coordination
- Difficulty in walking, standing, or sitting
- Loss of bladder and bowel control in advanced cases
- Spasticity in the extremities, leading to stiffness and restricted movement
Diagnosis of Cervical Myelopathy
The diagnosis of cervical myelopathy is based on a combination of clinical evaluation and imaging studies:
- Clinical History and Physical Examination: A thorough patient history and neurological examination help identify characteristic symptoms such as hand dysfunction, gait disturbances, and reflex abnormalities.
- MRI Scan: The primary diagnostic tool, MRI provides detailed visualization of spinal cord compression, disc herniation, and ligamentous changes.
- X-rays: Used to assess spinal alignment, bone abnormalities, and instability.
- CT Scan: Recommended for patients with ossified spinal ligaments or when MRI is contraindicated (e.g., patients with pacemakers, cochlear implants, or certain metallic implants).
- Electromyography (EMG) and Nerve Conduction Velocity (NCV) Studies: These tests are performed when there is a discrepancy between MRI findings and clinical symptoms. They also help differentiate myelopathy from peripheral nerve disorders such as diabetic neuropathy or carpal tunnel syndrome.
- Blood Tests: Evaluations for vitamin B12 deficiency, infections, or tumors.
- Additional Tests: If an infection or tumor is suspected, further investigations such as CT-guided biopsy, histopathology, and culture tests may be required.
Treatment Options for Cervical Myelopathy
Cervical spinal stenosis is an irreversible condition, and treatment is primarily focused on symptom management and preventing further deterioration. The approach depends on the severity of symptoms and the patient’s response to initial treatment.
- Medical Management
- Pain management: A combination of analgesics and muscle relaxants to relieve pain and discomfort.
- Nerve-stabilizing medications: These help reduce nerve-related symptoms like tingling and numbness.
- Spinal bracing: Used to restrict excessive movement and provide support to the cervical spine.
- Activity modification: Patients are advised to avoid activities that may worsen symptoms.
- Epidural Injections
- Epidural steroid injections may provide temporary relief for radiculopathy symptoms by reducing inflammation around the nerve roots.
- However, they do not reverse spinal stenosis and are not effective for severe cases of myelopathy.
- Not recommended for patients with uncontrolled diabetes or those on blood-thinner medications.
- Surgical Decompression of the Spinal Cord
Surgery is indicated for patients with severe symptoms or those who do not respond to conservative treatment. The goal of surgery is to relieve pressure on the spinal cord and prevent further neurological deterioration.
Surgical Options:
- Anterior Cervical Spine Surgery:
- Utilizes a minimally invasive approach with a microscope to perform Anterior Cervical Discectomy and Fusion (ACDF) or Corpectomy.
- Recommended for cases where the primary compression is anterior.
- Posterior Cervical Spine Surgery:
- Suitable for cases with posterior or multi-level compression.
- Procedures include laminectomy (with or without fusion) or laminoplasty.
- In some cases, a combination of anterior and posterior approaches may be required for optimal decompression.
Prognosis and Importance of Early Intervention
Cervical myelopathy is progressive and irreversible if left untreated. Early surgical intervention is strongly recommended once symptoms begin to affect daily activities, as prolonged spinal cord compression can lead to permanent neurological damage. Delaying surgery increases the risk of incomplete recovery, even after decompression.
Thoracic Myelopathy: A Related Condition
Thoracic myelopathy is a similar condition affecting the thoracic spinal cord. Unlike cervical myelopathy, it does not affect the upper extremities. Instead, symptoms typically include:
- Spasticity and weakness in the legs
- Difficulty with standing and walking
- Loss of bladder and bowel control
The most common cause of thoracic myelopathy is ossification of spinal ligaments, which is often associated with fluorosis. The diagnostic and treatment approaches for thoracic myelopathy are similar to those for cervical myelopathy.
Conclusion
Cervical myelopathy is a serious condition that requires timely diagnosis and appropriate management. While non-surgical treatments may provide temporary relief, surgical decompression remains the definitive treatment for severe cases. Early intervention is crucial to preventing irreversible spinal cord damage and improving the patient’s overall quality of life.
If you or someone you know is experiencing symptoms of cervical myelopathy, consult a spine specialist promptly to discuss the best course of action.
FAQs
Non-surgical treatment, including physical therapy, medications, spinal bracing, and epidural injections, can temporarily relieve symptoms but does not reverse spinal cord compression. Surgery is recommended for moderate to severe cases to prevent permanent nerve damage.
Recovery varies by procedure:
ACDF (Anterior Cervical Discectomy and Fusion): 6-12 weeks for basic recovery, full improvement in 6-12 months.
Laminectomy/Laminoplasty: Initial recovery in 4-6 weeks, but full neurological recovery may take 6-18 months depending on nerve healing.
Yes. Severe and untreated cases may lead to quadriparesis (weakness in all four limbs) or complete paralysis due to prolonged spinal cord compression. Early intervention can prevent irreversible damage.
Success rates depend on early intervention. Studies show:
80-90% of patients experience symptom stabilization or improvement.
Patients who delay surgery have reduced chances of full recovery due to permanent spinal cord damage.
Yes, in advanced cases. Severe mobility impairment, loss of fine motor skills, and bladder dysfunction can qualify as a disability. Many countries provide disability benefits for patients with significant functional limitations.
Recommended exercises include:
Neck stretches & isometric exercises to maintain mobility.
Balance exercises to improve coordination.
Grip-strengthening exercises to improve hand function.
Low-impact activities (swimming, walking) to maintain strength without excessive strain.
While uncommon, some patients experience dizziness due to poor balance control. Cervical spine issues can also affect blood flow to the brain, potentially leading to vision disturbances or headaches.
Avoid heavy lifting and repetitive neck strain.
Use ergonomic support (correct chair height, neck pillows).
Maintain a healthy weight to reduce spinal stress.
Regular low-impact exercise to keep muscles active.
No. Spinal cord damage from prolonged compression is irreversible. However, early surgery can halt progression, and rehabilitation can improve function over time.
Without treatment, symptoms progress to:
Severe weakness and difficulty walking.
Complete loss of fine motor skills in hands.
Loss of bladder and bowel control.
Permanent spinal cord damage and disability.
Yes. Patients often experience neck stiffness, pain, and discomfort while lying down. Using a cervical pillow and maintaining a proper sleeping position can help reduce symptoms.
