Myelopathy refers to any condition in which the spinal cord tissue is severely compressed, causing dysfunction of the spinal cord. While myelopathy can occur due to trauma (injury) or congenital stenosis (spinal canal narrowing due to a birth defect), it is typically caused by degenerative conditions that affect older adults. In fact, cervical myelopathy is the most common spinal disorder for Americans over age 55.
Myelopathy can occur in any area of the spine; however, it most commonly affects the cervical spine (neck). It is less common in the mid (thoracic) or lower (lumbar) spine.
Causes
While osteoarthritis, which is referred to as wear-and-tear damage, is the most common cause of spinal cord dysfunction (myelopathy), there are a number of other possible causes. These include:
- Bone spurs
- Bulging disc(s)
- Congenital abnormality or genetic predisposition
- Dislocation fracture
- Infection
- Injury or trauma (e.g. car accident, high-impact sports)
- Multiple sclerosis or other autoimmune disease
- Rheumatoid arthritis
- Spine misalignment (scoliosis)
- Tumor of the spine, benign or cancerous
- Various bone diseases
Symptoms
Myelopathy can cause a variety of symptoms, mostly related to abnormal or impaired functioning. However, a great number of cases of cervical spinal compression are asymptomatic (without symptoms). Therefore, it is important that those cases be detected and monitored so that the condition does not become worse, causing actual dysfunction.
Symptoms include:
- Pain or stiffness in the neck, shoulders and/or arms
- Numbness, tingling or weakness in the arms and legs
- Difficulty with balance
- Difficulty bending or turning the neck or back
- Difficulty walking
- Heavy feeling in the legs
- Fatigue in the limbs
- Sensation of shock or electrified feeling in the limbs
- Bladder or bowel complications
- Clumsiness, problems with hand-eye coordination
- Changes in sexual function
Diagnosis
A careful analysis is required to determine the presence of myelopathy or spinal cord compression. It begins with the doctor taking a thorough medical history and conducting a neurological examination, which includes evaluation of sensory and motor functions.
Sensory exams explore:
- Eyesight
- Eye movement
- Hearing
- Touch
Motor function tests include:
- Balance
- Coordination
- Gait
- Muscle function
- Range of motion
- Reflexes
Possible imaging tests include X-rays and magnetic resonance imaging (with or without myelography to enhance other imaging results). Imaging results are combined with the other components of the doctor’s exam and medical history in order to confirm a diagnosis.
Diagnosis is critical for this condition. Most often, for those who are symptomatic, those symptoms increase over time. While it may be very rare, progressive myelopathy can lead not only to weakness but also to paralysis.
Treatment
A number of noninvasive, conservative measures may provide relief for myelopathy, depending on the type and extent of the condition. These include:
- Lifestyle changes, which can range from eliminating smoking and poor eating habits to avoiding painful movement and postures.
- Physical therapy, which provides strength and mobility of the area in and around the spine.
- Soft collars, which can be used to support and protect the neck for those with cervical myelopathy.
- Therapeutic massage, which is helpful for muscle relaxation.
While these measures may help relieve symptoms and manage the myelopathy, they cannot prevent it. If symptoms do not improve or they progress with this type of noninvasive treatment, and pain is incapacitating and function severely diminished, surgery may be recommended. The goal of surgery is to relieve symptoms by “decompressing” the spine. This is done by creating more space for the spinal cord.
Surgery may include a laminoplasty, which is spinal decompression without fusion. When spinal decompression with fusion is indicated, it can be either anterior spine decompression (which is done from the front), or posterior spine decompression (done from the back).
At University Orthopaedic Associates (UOA), we bring 45 years of experience to the diagnosis and cutting-edge treatment of spine conditions. This includes Myelopathy/spinal cord compression. Contact us for a consultation.
