Cervical Myelopathy

Symptoms arise from the interruption of the normal flow of nerve impulses through the spinal canal. Myelopathy symptoms are a warning that requires urgent medical evaluation.

Symptoms depend on the location of the compression.

Compression of the spinal cord in the neck produces symptoms that include:

• Pain and stiffness in the neck.
• Weakness in the arms, hands and shoulders.
• Shooting pain that runs down the spine from the neck.
• Numbness and tingling in the arms, hands or legs.
• Changes in fine motor skills like dexterity and grip strength, changes in handwriting, hand clumsiness, poor coordination, difficulty buttoning clothing and other fine motor skills.
• Difficulty walking, loss of balance and coordination in the legs.

The most frequent cause of Cervical Myelopathy is spondylosis, meaning age-related changes in the bones, ligaments and discs that gradually cause narrowing of the spinal canal (cervical spinal stenosis). The specific changes involved include bulging or herniated discs, bone spurs, or thickened ligaments surrounding the spinal cord, any of which can cause compression of the nerves in the neck.

Aside from age-related changes, other causes include:

• Trauma
• Rheumatoid Arthritis
• Congenital abnormalities such as a narrow spinal canal from birth

Diagnosis involves a combination of clinical examination including patient history, physical exam and imaging studies. Dr. Colman will review your medical history, review your symptoms, function, and a timeline of your pain, inquire about whether the pain radiates, and whether there was any inciting event that caused the pain.

Dr. Colman may ask you to fill out questionnaires such as the mJOA score or Neck Disability Index, which are meant to measure disease severity based on your own perceptions.

He will perform a physical examination where he will check your muscle strength, reflexes, movements and nerve function.  He will also order imaging studies including:

• X-rays to rule out fractures and other potential causes of neck pain
• MRI scans to see a detailed image of the spine and spinal canal which can reveal spinal stenosis and disc herniations.
• CT myelogram of the neck is a diagnostic imaging test to look for problems in the spinal canal when MRI is not possible.
• Electromyography (EMG) and nerve conduction studies to assess nerve function and pinpoint affected nerves.

The treatment of cervical myelopathy depends on the severity of the condition and the patient’s overall health:

• For mild cases, conservative management will include the use of anti-inflammatory medications, physical therapy, and activity modification to relieve symptoms. Corticosteroid injections may be appropriate to relieve pain and promote healing.
• For cases of progressive symptoms or symptom durations longer than several months, surgery may be required to eliminate the spinal cord compression. Most surgeons agree that progressive symptoms, long term symptoms, or high grade spinal cord compression with any duration of symptoms requires early surgical intervention as opposed to observation.
• Surgery may be performed in a variety of manners, from the front or back of the neck:
  • Anterior Cervical Discectomy and Fusion (ACDF) is a surgical procedure used to address issues in the cervical spine, such as herniated discs, degenerative disc disease, or cervical myelopathy. The procedure involves removing a problematic intervertebral disc, decompressing the spinal cord, and fusing the adjacent vertebrae to stabilize the spine.
  • Anterior Cervical Discetomy and Total Disc Arthroplasty is a surgical procedure very similar to ACDF, except that instead of fusing the spine after discectomy and decompression, a motion preserving implant is placed. This procedure is most appropriate for younger patients without advanced arthritis, instability, or poor bone quality.
  • Posterior laminectomy and fusion is another option to thoroughly decompress the spinal cord over multiple levels in the absence of alignment problems such as kyphosis (tipping forward).
  • Posterior cervical laminoplasty is a non-fusion option to thoroughly decompress the spinal cord over multiple levels in the absence of alignment problems such as kyphosis (tipping forward). This is a less-invasive “canal expanding” option.