An injury or compression to the spinal cord causes cervical myelopathy, which can cause nerve damage and a variety of symptoms. Cervical myelopathy occurs when something compresses or squeezes the spinal cord in the neck area, causing nerve damage and a variety of symptoms. Injuries, infection, tumors, and congenital abnormalities can all contribute to cervical myelopathy, which can lead to serious complications. If left untreated, chronic pain, disability, and paralysis can occur.
In most cases, cervical myelopathy is caused by cervical spondylosis, which occurs as a result of aging degeneration of the spine. As the spine ages, its discs lose their water content and become thinner, its joints become inflamed and develop bone spurs, and its ligaments become stiff and calcified. Inflammation and compression can result from these changes, which narrow the spinal cord and nerve roots.
Other causes of cervical myelopathy include:
Spinal stenosis, which is the narrowing of the spinal canal due to various reasons, such as arthritis, disc herniation, or bone overgrowth.
Spinal trauma, which is an injury to the spine that can fracture, dislocate, or damage the vertebrae, discs, or ligaments, causing pressure on the spinal cord.
Spinal tumor, which is an abnormal growth of cells in or around the spine that can invade or compress the spinal cord or its blood supply.
Spinal infection, which is a bacterial or fungal infection that can affect the vertebrae, discs, or spinal cord, causing inflammation and abscess formation.
Spinal cord malformation, which is a birth defect that affects the development of the spine or the spinal cord, such as spina bifida, syringomyelia, or Chiari malformation.
Some risk factors that can increase the likelihood of developing cervical myelopathy are:
Age: Cervical myelopathy is more common in older adults, especially over 50 years old, due to the natural wear and tear of the spine.
Genetics: Cervical myelopathy can run in families, especially if there is a history of spinal cord malformation or congenital spinal stenosis.
Lifestyle: Cervical myelopathy can be influenced by habits that affect the health of the spine, such as smoking, obesity, lack of exercise, poor posture, or repetitive strain.
Occupation: Cervical myelopathy can be associated with jobs that involve heavy lifting, bending, twisting, or vibrating of the spine, such as construction, mining, or driving.
Sports: Cervical myelopathy can be related to sports that involve high-impact, contact, or extreme movements of the spine, such as football, rugby, gymnastics, or diving.
Cerebral myelopathy symptoms vary depending on the severity and location of the spinal cord compression. They can range from mild to severe, and they can affect a wide range of body parts, such as the neck, arms, hands, legs, or bladder. As well as developing gradually or suddenly, the symptoms can also worsen over time or fluctuate over time.
Some common symptoms of cervical myelopathy are:
Neck pain or stiffness, which can radiate to the shoulders, arms, or head.
Numbness, tingling, or weakness in the arms, hands, fingers, legs, or feet.
Difficulty with fine motor skills, such as writing, buttoning, or holding objects.
Difficulty with balance, coordination, or walking, which can cause falls or stumbling.
Loss of bladder or bowel control, which can cause incontinence or retention.
Spasticity, which is increased muscle tone or stiffness that can cause spasms or jerks.
Hyperreflexia, which is exaggerated reflexes that can cause twitching or clonus.
Sensory changes, such as reduced or altered sensation to touch, temperature, or pain.
Sexual dysfunction, which can affect the ability or desire to have sexual intercourse.
Based on the medical history, physical examination, and imaging tests, cervical myelopathy can be diagnosed. The doctor will ask about the onset, duration, frequency, and severity of the symptoms, as well as possible risk factors or underlying conditions. As part of the neurological examination, the doctor will assess the strength, sensation, reflexes, and coordination of the limbs, as well as the function of the spinal cord and the nerve roots.
The imaging tests that can help confirm the diagnosis of cervical myelopathy are:
X-ray, which can show the alignment, shape, and size of the vertebrae, as well as any signs of degeneration, fracture, or infection.
MRI, which can provide a detailed view of the spinal cord, discs, ligaments, and nerves, as well as any evidence of compression, inflammation, or tumor.
CT scan, which can produce a cross-sectional image of the spine, and can detect bone spurs, calcification, or stenosis.
Myelogram, which is a special type of X-ray that uses a contrast dye injected into the spinal canal to highlight the spinal cord and nerve roots, and can reveal any narrowing or obstruction.
EMG, which is a test that measures the electrical activity of the muscles and nerves, and can show how well they are functioning.
Depending on the cause, severity, and progression of cervical myelopathy, treatment options vary. In order to relieve pressure on the spinal cord, prevent further damage, and improve quality of life, the treatment options are divided into conservative and surgical methods.
Conservative treatment of cervical myelopathy includes:
Medication, such as analgesics, anti-inflammatories, muscle relaxants, or steroids, to reduce pain, swelling, or spasm.
Physical therapy, which can include exercises, stretches, massage, heat, ice, or electrical stimulation, to improve the strength, flexibility, and mobility of the spine and the limbs.
Bracing, which can involve wearing a soft or rigid collar, to support the neck and limit its movement, and to allow the spinal cord to heal.
Lifestyle modification, which can include quitting smoking, losing weight, avoiding alcohol, eating a balanced diet, and practicing good posture, to protect the spine and prevent further deterioration.
When conservative treatment for cervical myelopathy fails, or when symptoms become severe, progressive, or disabling, surgery is usually recommended. The type of surgery depends on the location and extent of the spinal cord compression, as well as the patient's age, health, and preference. Common surgical procedures for cervical myelopathy include:
To stabilize the spine and create more space for the spinal cord, anterior cervical discectomy and fusion (ACDF) involves removing the damaged disc and bone spurs from the front of the spine and fusing the adjacent vertebrae with a bone graft and a metal plate and screws.
This procedure involves removing the lamina (the back part of the vertebra) and any bone spurs from the back of the spine and fusing the adjacent vertebrae with rods and screws to decompress the spinal cord.
A cervical laminoplasty involves cutting and lifting the lamina on one or both sides of the spine and inserting a spacer or plate to create a hinge, expand the spinal canal, and preserve the spine's motion.
Replacement of the damaged cervical disc with a synthetic device that mimics the natural disc, in order to restore the height and function of the spine without fusion.
The prevention of cervical myelopathy is not always possible, especially if it is caused by aging or genetics. However, some measures that can help reduce the risk or delay the onset of cervical myelopathy are:
Maintaining a healthy lifestyle, such as exercising regularly, eating well, sleeping enough, and managing stress, to keep the spine strong and flexible.
Avoiding smoking, drinking, or using drugs, which can impair the blood flow and nutrition of the spine, and accelerate its degeneration.
Practicing proper ergonomics, such as using a comfortable chair, desk, and computer, and adjusting the height, angle, and distance of the screen, keyboard, and mouse, to prevent neck strain and posture problems.
Taking breaks and stretching, especially if working or studying for long hours, or doing repetitive tasks, to relax the muscles and joints of the spine, and to improve the circulation and oxygenation of the spinal cord.
Wearing protective gear, such as helmets, pads, or braces, when playing sports or engaging in activities that can injure the spine, such as biking, skiing, or climbing.
Seeking medical attention, if experiencing any symptoms of cervical myelopathy, such as neck pain, numbness, weakness, or difficulty with coordination, to get an early diagnosis and treatment, and to prevent further complications.
