Cervical Myelopathy: Causes, Symptoms, and Treatment

Medically reviewed by Achuta Uppu, MD, Internal Medicine. Last reviewed: October 23, 2026.

What kind of doctor treats Cervical Myelopathy?

A neurosurgeon, a surgeon who treats the brain and spine, usually treats cervical myelopathy. An orthopedic spine surgeon or a neurologist (a nerve doctor) may also be involved. A direct primary care or concierge doctor can be a first stop for an evaluation and can refer you to a specialist when needed.

What is cervical myelopathy?

Cervical myelopathy is injury to the spinal cord in the neck. It happens when the spinal canal narrows. The narrowing can pinch the spinal cord and nerve roots. The spinal canal runs through the vertebrae (back bones) and carries the spinal cord. The spinal cord holds the nerves that give strength and feeling to the arms and legs. It also helps control the bladder and bowels. Cervical stenosis is the name for the narrowing itself. Myelopathy means the spinal cord is hurt and not working well.

Symptoms

About half of people with cervical myelopathy have pain in the neck or arms. Most have trouble with the arms and legs. Symptoms can include:

  • Weakness, stiffness, or clumsiness in the hands, like trouble buttoning a shirt.
  • Leg weakness, trouble walking, or frequent falls.
  • Loss of sensitivity (less feeling) in the hands or feet, sometimes making it hard to button a shirt.
  • Urinary urgency (a sudden strong need to pee), which is also common. In late cases, bladder and bowel incontinence (leaking urine or stool) can occur.

Symptoms may grow slowly, stay stable for a while, or get worse fast. Gait (walking) trouble is often an early sign.

Causes and who gets it

The most common cause is cervical spondylosis, the wear and tear of the spine with age. As the spine ages, discs (the soft pads between the bones) lose water and thin out. Bones and ligaments thicken and push into the canal. These changes are common after age 50. Discs can also harden and bulge into the spinal canal. Other causes include a tumor, an infection, or a blood collection near the cord. Cervical spondylosis is the most common cause of myelopathy in adults above the age of 55.

How doctors diagnose it

Your doctor will ask about your symptoms and do a physical and nerve exam. The exam may find increased reflexes in the knees and ankles, changes in walking, or less feeling in the hands or feet. An MRI (a scan that uses magnets to make detailed pictures) is often used. It shows the tight canal and any pinching of the spinal cord. X-rays may rule out other problems, but they may not confirm stenosis. A CT scan (an x-ray scan that shows bone clearly) can show bone pushing into the canal. It can be combined with myelography, a dye injected around the spinal cord and nerves. An EMG (a test of muscle and nerve signals) may help rule out a pinched nerve in the neck or arm.

Treatment

In mild cases, nonoperative care may be suitable. It can include physical therapy, staying away from high-risk activities, and pain medicines such as anti-inflammatory drugs or muscle relaxants. If weakness or pain grows, or you become unable to walk, surgery is usually recommended. Surgery always involves removing pressure from the spinal cord and spinal nerves, called decompression. Options include anterior decompression and fusion, which removes disc and bone from the front and uses a bone graft, often with a metal plate and screws, to hold the spine steady. A laminectomy removes bone and ligaments pressing on the cord from the back of the neck. A laminoplasty reshapes the bone to open a hinge and make more room for the cord. Pain medicines should be taken only as directed. Taking more will not help you recover faster and can cause side effects or addiction.

When to see a doctor

Call 911 or go to the emergency room right away if you have signs of spinal cord compression, such as sudden weakness or numbness in your arms or legs, sudden trouble walking, not being able to pass urine, or loss of control of urine or stool. Do the same if you have new nerve changes after a neck injury, even a minor one. If weakness, clumsiness, or loss of feeling grows slowly, see your doctor soon. Early detection is important because treatment may help slow symptom progression.

How a direct primary care or concierge doctor fits in

A direct primary care doctor charges a flat monthly fee instead of billing insurance, while a concierge doctor usually charges more and often works alongside insurance. Either can check your nerves over time and coordinate your care with a spine specialist. They can also help manage pain medicines safely.

Common questions

Can cervical myelopathy get worse without treatment?

Untreated cervical myelopathy may get worse slowly. Walking, arm and leg strength, feeling, and pain can all decline over time.

What is the difference between cervical stenosis and myelopathy?

Cervical stenosis is the name for the actual narrowing of the canal. Cervical myelopathy means injury to the spinal cord and its function. Stenosis does not always cause symptoms.

Does surgery help cervical myelopathy?

After surgical decompression, 50% to 80% of patients report improvement in symptoms, while 5% to 30% may worsen. Surgery always involves removing pressure from the spinal cord and spinal nerves. It is usually recommended when weakness or pain grows, or you become unable to walk.

What is hyperreflexia?

Hyperreflexia means reflexes (automatic muscle responses) are stronger than normal. Increased reflexes in the knees and ankles are often the first signs of myelopathy. Doctors look for them during a neurologic exam.

Sources

  1. North American Spine Society - Cervical Stenosis and Myelopathy (Know Your Back)
  2. NCBI Bookshelf - Spinal Cord Compression (StatPearls)

Medical Disclaimer

This content is for general educational and informational purposes only and is not medical advice. It is not a substitute for professional medical advice, diagnosis, or treatment, and reading it does not create a doctor-patient relationship. Always seek the advice of your physician or another qualified health provider with any questions about a medical condition, and never disregard or delay seeking professional advice because of something you read here. If you think you may have a medical emergency, call 911 (or your local emergency number) immediately.