An Overview of Cervical Myelopathy

Cervical myelopathy is a condition that often occurs in middle-aged and older individuals as they shift into middle-age and into the 60s and 70s. It may show up very slowly and lead to substantial problems without sufficient warning signs.

Myelopathy can be a tricky diagnosis to make as it often occurs in a subtle fashion and at times the work up can be non-definitive. Typically cervical myelopathy presents with a few telltale signs and symptoms. If a person comes in and says that they are having difficulty walking and feel like they are off-balance all the time, that may be an indicator of myelopathy. In addition, the individual may state that they are having a tough time with handwriting, or possibly buttoning up their shirts.

The signs and symptoms may be subtle and there may be no pain in the individual's neck. There may be a lot of pain if the patient has concomitant arthritis in the neck. Even if there's no pain, surgery may still be necessary.

The work up for cervical myelopathy includes a physical examination to watch the patient ambulate, to check their manual dexterity, and to look for hyperreflexia to see if those are present.

An MRI study will often show some signal changes within the spinal cord due to something compressing on it. This may be arthritis with overgrowth from either soft tissue or bone, a tumor, a result of a fracture with the bone healing improperly, or something else such as a disc herniation compressing on the spinal cord and causing it to react.

The tricky part may come and if there are no signal changes seen on MRI and no big time compressive elements on the spinal cord. It may take a while for the spinal cord to 'react" to being compressed. One month the spinal cord may look completely normal in size, density, and contrast on the MRI, and the next compression may cause it to have shrunk a bit and have a bright signal to it. Unfortunately, this may not be reversible if it progresses. It's unpredictable.

Another great study in the work up for myelopathy is a nerve conduction and electromyography study. This can show to what extent nerve roots are being affected by the myelopathy. You can also help distinguish between cervical stenosis which is compression of multiple nerve roots as they are trying to get out from the neck, versus cervical myelopathy which is compression of the spinal cord itself.

Treating cervical myelopathy is not a black and white issue. Surgery for cervical myelopathy is definitely indicated if the condition is getting worse in front of the physician's eyes on follow-up visits. The reason is that when you do surgery to decompress the areas on cervical myelopathy that are the problem, you can typically stop the progression of the disease but often not reverse it.

The type of surgery to do for cervical myelopathy is questionable and depends upon where the compression is occurring and how broad it is, as it may only be necessary to do a decompression and not a fusion. More often than not however, along with decompressing the tight areas, the surgeon will perform some kind of fusion to stabilize the area.

Cervical myelopathy is very treatable if seen early. If it's seeing late, the outcome may be sub optimal as even if the surgery is technically done perfectly, it may be impossible to reverse the damage that has been done.