Cervical myelopathy is a degenerative change within the spinal column that can result in the compromising of the neurological functioning of the extremities (1). One of the most interesting features in regards to this condition is that it can be caused by multiple different scenarios. If left untreated, cervical myelopathy can be degenerative and lead to problems with coordination, mobility and daily activities. Although it is prevalent in older generations, there are other instances when this ailment can occur at a younger age. Let us now take a more in-depth look at this type of myelopathy as well as examine some of the treatment options which are available.
It is first important to understand that this myelopathy is a result of cervical stenosis. In other words, it can be present alongside typical stenosis. Stenosis is simply defined as a narrowing of the channel which houses the spinal cord (2). In the case of myelopathy, the symptoms tend to be less transient when compared to a standard stenosis of the spine. Myelopathy can also be more difficult to treat, as its root causes are quite varied.
As stated previously, there can be many conditions which lead to the onset of this condition. Some of the most prevalent include:
Herniation and spondylosis may have treatment options with the use of a spinal surgeon or a neurosurgeon. As can be imagined, many of these symptoms can manifest later in life when the spine is weaker or the immune system is already compromised.
The co-morbidity of myelopathy alongside spinal stenosis can cause problems in terms of diagnosing the symptoms. For the sake of brevity here, we will only concern ourselves with the indicators that are predominant with myelopathy (while these MAY also be present within a stenosis). A handful of the most common symptoms are:
Clumsiness and a general feeling of physical malaise are often present in many cases. The progression of this illness will vary from patient to patient and not everyone will experience all of these symptoms. It is interesting to observe that pain in one or both of the arms will normally cause an individual to seek treatment, as these symptoms can sometimes mirror a heart attack.
While this is indeed a discrete medical condition, an accurate diagnosis can sometimes prove challenging. This is largely due to the fact that presentations will vary and there can be multiple underlying causes (3). Several techniques are therefore employed to obtain an accurate conclusion. These normally include a detailed patient history, genetic predisposition and radiographic imaging (X-rays or CT scans). The main indicators will be a physical compression of the spinal cord alongside a narrowing (stenosis) of the canal itself.
Magnetic resonance imaging (MRI) and Post-myelography computed tomography (myelo-CT) are other methods which are becoming more prevalent due to their ability to provide clearer pictures of the cervical region. These can also help to highlight the areas which need to be addressed by surgery. The doctor will usually correlate the discrete symptoms of the patient with where the narrowing is located. Should these coincide, an accurate diagnosis of cervical myelopathy is possible.
Some physical examinations such as observing the deep tendon reflexes in the knee and a flexing of the index finger when the middle finger is "flicked" (Hoffman's reflex) may also indicate the presence of cervical myelopathy (4).
As the root cause of this condition is pressure within the cervical region of the spine, most treatments involve alleviating the pressure. Although anti-inflammatory medication may be provided for short-term conditions (such as after trauma), the most common option is surgery. However, it should be observed that the symptoms may or may not improve after any such procedure. An informed prognosis is therefore important before any decision is made.
The two primary options are surgery through the front of the neck and via the rear. These are technically referred to as:
There can also be times when both methods are used simultaneously (3). The doctor will base his or her decision upon where the stenosis is located and the curvature of the cervical spine. Additionally, these options will need to take into account the physical condition of the patient as well as the severity of the symptoms. Surgery is primarily intended to relieve compression and to curtail the progressive nature of the cervical myelopathy.
As should be expected, the overall prognosis of the patient will involve several metrics. Some of these can include (but are not necessarily limited to):
Should multiple different locations need to be treated (as can be the case with a more advanced illness), the overall recovery time will be lengthened. Ultimately, the symptoms could eventually disappear or they may be present to a lesser degree well into the future.
This is a basic overview of cervical myelopathy. Those who believe that they may be suffering from this condition should always seek out the advice of a trained medical professional for an accurate diagnosis.