Myelopathy

Myelopathy Overview

Myelopathy refers to disorders of the spinal cord that cause loss of nerve function. The most common type is cervical myelopathy, which affects the neck, also known as the cervical spine, and the upper and lower extremities (arms and legs). A less common type, thoracic myelopathy, involves the body from the chest down.

Myelopathy is often a result of spinal stenosis, in which the nerves in the spinal canal are compressed. This compression is due to disk degeneration that comes with aging and wear and tear on the neck. Other causes include neck fracture or other types of trauma, inflammation, and autoimmune disorders, tumors and ruptured or herniated disks.

Cervical myelopathy is a common source of spinal cord problems in older people. The condition tends to “creep up” over time, causing symptoms like neck discomfort and subtle changes in the way the hands work. The course of the condition varies. Some patients will experience a slow or steady deterioration in function, while a smaller percentage will experience a rapid deterioration.

If you or your primary care physician believes you might be suffering from cervical myelopathy, make an appointment to visit a Wellstar neurologist as soon as possible. They are expert in diagnosing and treating myelopathy and ruling out other conditions with similar symptoms.

Symptoms

About half of patients with cervical myelopathy experience pain in the neck and into the arms and legs. Symptoms include weakness, stiffness, or clumsiness in the hands that can lead to difficulty with activities like using buttons or turning a doorknob. Leg issues include weakness, difficulty walking or frequent falls.

Other symptoms:

Increased knee and ankle reflexes (which may only be detected during a neurologic exam).
A feeling of unsteadiness or a wobbly gait.
Urinary urgency.
Numbness, and bladder and bowel incontinence in later stages.

Risk Factors

While there is not much one can do about wear and tear on the spine, certain factors increase the chance of developing cervical myelopathy. Among these:

Infections
Restricted blood supply, known as ischemia
Autoimmune diseases like rheumatoid arthritis and multiple sclerosis and other conditions such as vascular disease or degenerative disease
A history of back or bone problems
Being born with a narrow spinal canal
Participating in work tasks or sports that involve regular stretching and straining of the spine
History of cancer involving the bones
Trauma leading to degenerative changes that affect the disks

Myelopathy Prevention

There is little you can do to prevent cervical myelopathy. But some precautions can help ensure that the condition does not worsen.

Use safe lifting techniques (lift with the muscles of the legs, not the back).
If your job requires significant lifting, talk with your supervisors about a change in duties.
Take precautions to avoid falls, such as using a handrail in the shower and getting rid of throw rugs and other hazards.
Avoid contact sports if you have had disk problems, including degeneration and compression of the spinal cord.

Myelopathy Diagnosis

In order to diagnosis the problem, your Wellstar neurologist will ask questions about how your symptoms began and have progressed. The doctor will conduct a physical exam focused on the neck and nerve function in your arms and legs. He or she will examine your gait and your balance and will look for:

Abnormal (overactive) reflexes
Weakness, especially in the arms
Numbness in the arms and hands
Atrophy (muscles that have shrunk or deteriorated)
Loss of sensitivity in the hands and/or feet
Decreases in range of motion or flexibility in the neck

Tools and Tests

Various imaging and diagnostic tests can help confirm a diagnosis of cervical myelopathy.

X-rays of the cervical spine to rule out other conditions
Magnetic resonance imaging (MRI) shows tightness in the spinal canal and pinching of the spinal cord
Computed tomography (CT) scan provides information about bony invasion of the canal
Myelography, a specialized CT in which contrast dye is injected to illuminate the spine. It shows the size of the spinal canal, bone spurs and other issues

Myelopathy Treatment

After confirming a diagnosis of cervical myelopathy, your Wellstar neurologist will recommend treatment, typically starting with non-surgical methods.

Non-surgical Treatment Options

Some patients get relief from symptoms using strategies including:
Wearing a soft cervical collar for a limited time. This limits neck motion and allows the muscles of the neck to rest. Wearing a collar can relieve some pinching of the nerve roots.
Modifying activity and changing ergonomics, such as altering the height of your computer monitor or readjusting your desk chair.
Doing exercises that help improve neck strength and flexibility. Talk with your doctor about seeking help from one of Wellstar’s highly trained physical therapists.
Taking non-steroidal anti-inflammatory medications (NSAIDs) such as aspirin and ibuprofen can help reduce swelling and pain.
Taking prescription anti-inflammatory medications, muscle relaxants and narcotic analgesics as needed for a short period.
Getting epidural steroid injections of cortisone, a powerful anti-inflammatory that helps decrease swelling and pain.

Surgery

When patients with cervical myelopathy experience increasing weakness, pain, or an inability to walk, surgery is an important option to consider. Two common indications that surgery may be needed:

Failure to improve after four to six weeks of non-surgical treatment
Progression of the symptoms despite nonsurgical treatment

If you are considering surgery you will have many questions for your neurologist. Surgery is a complex matter and you will want to fully understand the benefits and the risks.

Surgical options include:

Anterior decompression and fusion. In this procedure the disk and bone material causing the spinal cord compression are removed from the front and the spine is stabilized by fusion. This involves placing an implant between the segments of the neck to support the spine. Small metal plates and screws may be added for strength.
Laminectomy is a procedure in which bone and ligaments pressing on the spinal cord are removed. Fusion to stabilize the neck may also be performed.
Laminaplsty is a surgery to decompress the cervical spine compressed by the buildup of bone spurs, discs or ligaments. The result is an increase in space for the spinal cord and a reduction in pressure/pain.

Ongoing Care for Myelopathy

Cervical myelopathy is a progressive condition that can worsen if left untreated. Many patients who pursue nonsurgical and surgical treatments experience a significant reduction in neck pain and other symptoms.

Wellstar neurologists recommend that those with any type of spinal dysfunction take steps to keep their spine functioning as well as possible.

Use good posture while sitting, standing, sleeping and working
Avoid excess weight through diet and appropriate exercise
Take precautions when lifting and carrying objects
Avoid fall risks
Quit smoking. Smokers are more prone to back pain than nonsmokers because nicotine restricts the blood flow to the disks