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With age, the spine may develop degenerative changes in the discs and facet joints of the spinal column. Such degenerative changes may slowly progress to cause a narrowed spinal canal, which is a condition known as stenosis. When the spinal canal is narrowed in the neck- it is a condition that is referred to as cervical stenosis. As the narrowing or the stenosis gets worse, the spinal cord itself can become compressed and diseased and cause the clinical condition that is cervical myelopathy. Cervical myelopathy may result from a herniated (ruptured or bulging) disc, and can be seen in combination with bone spurs in the spinal canal (cervical spondylosis) also known as osteophytes.
Signs and Symptoms of Cervical Myelopathy
Depending on how severe the condition is and the length of time of the spinal cord compression, symptoms may range from mild to extreme. People with cervical myelopathy may experience one or more of the following signs and symptoms:
| Hand Dysfunction |
Patients often complain of their hands “not feeling right” and/or of a clumsiness that manifests itself by difficulty with buttoning a shirt, holding on to small objects, and dropping things unknowingly are common complaints. |
Handwriting |
Patients often notice a definite worsening of their handwriting over a specific amount of time. |
Walking Difficulty |
Balance is often affected with advanced myelopathy. Patients complain of unsteadiness on their feet when attempting to walk. Family members often notice this symptom. Leg weakness may also be noticed and patients may use walking aids to help with their balance. |
Neck Pain |
Only about half of patients with cervical myelopathy will have neck pain; usually due to the degenerative process rather than as a result of the stenosis itself. |
Urinary Complaints |
Urinary urgency is often associated with myelopathy, however, urinary incontinence may happen with advanced cases. |
Cervical Myelopathy Diagnosis
Diagnosis is made by the physician’s careful history and physical exam and imaging studies. X-rays, MRIs, and Myelography (or the intrathecal injection of a contrast agent) used in conjunction with computed tomography (CT) scans are used to confirm the diagnosis of cervical myelopathy.
Treatment for Cervical Myelopathy
Except for very mild cases, once cervical myelopathy is diagnosed and confirmed by the examination and imaging studies, surgical intervention is generally recommended. The goal of surgical intervention is to stop the progression of the disease by spinal cord decompression and sometimes by stabilizing the spine. There are several different surgical options for the treatment of cervical myelopathy. Several factors influence the surgeon when making the appropriate surgical planning. The alignment of the cervical spine (Kyphosis or Lordosis), the location of the spinal cord compression (behind the disc or behind the vertebrae), the extent of the spinal cord compression (single level or multiple levels in the neck) and the patient’s medical condition are all critical factors in making the right treatment decisions.
Anterior Cervical Discectomy and Fusion (ACDF), Cervical Corpectomy and Fusion, Cervical Laminectomy (with or without fusion), and Cervical Laminoplasty are all procedures utilized in the management of this complex condition. It is important for patients to make sure their surgeon is experienced with all of these techniques as well as other minimally invasive options, and is able to customize a treatment that is aimed at maximizing the benefit of the surgery and minimizing the complications. |
