What Is Cervical Myelopathy

Cervical Spinal Myelopathy is caused by deterioration in the spine in the neck leading to compression of the spinal cord and symptoms such as “numb” and “clumsy” hands, loss of coordination, imbalance, bladder and bowel problems, and weakness that can progress to severe paralysis.

Why does it matter?
Aside from the significant and disabling symptoms, Cervical Spinal Myelopathy is a very common condition; it is the most common cause of spinal cord damage and it will affect most people if they live long enough!

The symptoms of Myelopathy are often mistaken for 'natural' consequences of ageing

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What are the symptoms?

Cervical myelopathy tends to creep up on patients in most cases. It can result in subtle changes in the way their hands work. Patients feel their hands are clumsier; they may drop objects more often, they may not be able to button their shirts as easily as they could, or their handwriting may become worse. Patients may develop unsteadiness, requiring holding onto objects more frequently while walking. Their gait may become noticeably wobbly. At times, they feel their brain doesn’t know exactly where their legs are in time and space. In extreme cases, patients may develop more profound weakness and numbness in their arms and legs and rarely changes in bowel or bladder control.

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Treating Myelopathy

Myelopathy and spinal cord injuries are serious and complex medical problems. In some cases, compression or pressure on the spinal cord will put pressure on nerves. This may cause pain, weakness, or a lack of control. If you have muscle weakness and pain, you may be asked to consider surgery in order to relieve the pressure on the nerves. Over time, pressure on a nerve can permanently damage it. While many cells in the body have the ability to repair themselves, nerve cells can, in some instances, be irreversibly damaged

The key to the treatment of cervical spondylotic myelopathy is to remove the pressure from the spinal cord. The surgery is performed to prevent the progression of symptoms; clinical improvement may or may not occur. You will need to discuss your prognosis with your Neurosurgeon prior to making a decision to have surgery.

Surgical procedures to decompress the spinal cord include approaches from the front of the neck (anterior cervical discectomy and fusion, anterior cervical corpectomy), from the back of the neck (cervical laminectomy, cervical laminectomy and fusion, cervical laminoplasty) and combined procedures in which both an anterior and a posterior approach are used. The exact procedure performed is based partly on the location of the stenosis and the overall alignment of the cervical spine, but many factors are considered in the decision.

Loss of the cervical lordosis

Cervical lordosis is a curve in the cervical spine, the area of the spine which contains the neck vertebrae. This curve is entirely normal and in fact desirable because it helps to stabilize the head and spine, but when the curve straightens out, becomes too deep, or faces in the wrong direction, it can become a problem. There are several treatments available for loss of cervical lordosis, with treatment being supervised by a medical professional who specializes in spinal care.

In a healthy spine, the cervical lordosis looks like a very wide C, with the C pointing toward the back of the neck. This can begin to straighten in a condition called cervical kyphosis, in which the curve straightens up or even bows in the other direction. Sometimes this is referred to as “reverse lordosis,” referencing the fact that the spine is still curved, but the curve is now running in the wrong direction. People can experience fatigue, strange head positioning, and other symptoms as a result of variations in the healthy cervical lordosis

Some people experience problems in the cervical spine as a result of inherited conditions. In other cases, it can be caused by injury, stress, strain, poor posture, or poor positioning. The earlier the problem is caught, the more treatment options are available, and the less likely complications will be. Alterations to normal cervical lordosis can be diagnosed with a regular physical exam, and with the assistance of tools such as medical imaging studies to view the spine.

One option may be physical therapy to strengthen the spine, potentially paired with exercises which are designed to encourage people to improve their posture and positioning. Things like support pillows for sleeping can be used to stabilize the neck while someone sleeps with the goal of arresting the damage. Bracing can also be an option for people with abnormal cervical lordosis, with the brace holding the spine in alignment.

For some patients, it may be necessary to perform surgery. Surgery for spinal fusion can address abnormal curvature by fusing the cervical vertebrae so that they cannot drift out of place, for example. Surgery is generally considered as a last resort because it can be risky, and the patient may experience permanent lifestyle changes. Fusion, for example, makes it difficult to turn the head and may make people vulnerable to injury because the spine loses some of its flexibility and elasticity.