Cervical myelopathy is a condition that occurs due to compression of the spinal cord in the neck.

The most common cause of cervical myelopathy is a disc prolapse of a significant degree. This results in compression and injury to the spinal cord. A lesion within the cervical spine can potentially compress the spinal cord, and cause myelopathy. Cervical myelopathy varies as in intensity as per the severity of compression in the spinal cord and also on the location of the compression. 

Diagnosis of cervical myelopathy

It is better to diagnose cervical myelopathy earlier to make the treatment successful. Cervical myelopathy has symptoms similar to ageing. As such, it can sometime be mistaken as symptoms of ageing such as development of weakness, difficulty with walking, change in bowel and bladder habits for example. For diagnosis of cervical myelopathy, the surgeon will conduct the following

  • Detailed history taking and neurological examination
  • Conduct relevant imaging tests such as MRI , CT and X rays with special views.
  • Occasionally there may be a need to perform electrodiagnostic tests such as nerve conduction studies and EMG’s

Symptoms of cervical myelopathy

A patient usually experiences the following symptoms:

  • Neck pain
  • Arm pain
  • Progressive stiffness in the arms or legs
  • Difficulty walking
  • Numbness and tingling
  • Bowel or bladder symptoms

Usually, the symptoms come on gradually. Symptoms can reappear at any time later on also. It is a condition that needs urgent evaluation and treatment. This is due to the potential of causing worsening and permanent cervical cord damage. Patients who have had this condition for a long period of time might also have a very spastic gait and associated muscle loss.

Cervical myelopathy treatment

The recommended treatment for this condition is surgical treatment. The options for surgery are guided by the extent of spinal cord compression. The deposition of bony material in the disk is another consideration factor. 

The usual operative approaches that are followed are a cervical discectomy and fusion. When the area of compression is over a longer segment, there might be a need to remove vertebral segments. This procedure is called a vertebrectomy. Posterior decompression with laminectomy or laminoplasty . 

The decision of anterior versus posterior surgery is taken by the surgeon after considering multiple clinical, radiological and patient factors. The aim of all surgical options is to achieve decompression of the spinal cord, without affecting the stability of the spine.

Other adjuncts in the treatment of cervical myelopathy include  physical therapy and use of a cervical collar brace. Physical therapy helps the pain, prevents neurological deterioration and improves neurological deficit. Physical therapy includes aerobic exercise, improving posture, dynamic upper and lower limb exercise and cervical stabilisation exercises.

Causes of cervical myelopathy

Generally, cervical myelopathy is caused due to the wear and tear in the spine. Besides this, there can be other causes such as the hardening of the ligament around the spinal cord. Some other causes of cervical myelopathy include:

  • Spinal infection
  • Rheumatoid arthritis of the neck
  • Whiplash injury or other cervical spinal trauma
  • Spinal tumors

Risk factors for cervical myelopathy

Multiple risk factors can lead to cervical myelopathy, some of which are listed below:

Complications of untreated cervical myelopathy

Cervical myelopathy can lead to long term and permanent damages, if the compression is severe. The condition can cause disabilities in patients, wherein the patient might not be able to move much and would be wheelchair bound.

Frequently asked questions 

What precautions should I take, if I have cervical myelopathy?

Some activities such as jumping, lifting heavy weights, running and strenuous exercises are to be avoided. These can make the condition worse for a patient.