Cervical myelopathy

Cervical myelopathy is spinal cord compression in the cervical spine (neck). Your cervical spine contains seven vertebrae (C1 to C7), with six intervertebral discs and eight nerve roots.

 

The spinal cord travels inside the vertebral column constructed by the front by vertebrae, cushioned by the intervertebral discs, and from the back by the facet joints.

In the cervical spine, eight nerve roots branch out that primarily control the function of your shoulders, arms, and hands.

Cervical myelopathy is when your spinal cord is compressed by any of the structures of your vertebrae.

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What causes cervical myelopathy

  • Age-related wear and tear

  • Ossification (hardening) of the ligaments surrounding the spinal cord

  • Rheumatoid arthritis of the neck

  • Whiplash injury or other cervical spine trauma

Symptoms

Cervical myelopathy produces two types of symptoms: local symptoms you may feel in your neck and systemic symptoms appearing elsewhere in the body.

The neck symptoms may include:

  • Neck pain

  • Stiffness

  • Reduced range of motion

As the disease progresses, you may experience shooting pain that originates in your neck and travels down the spine.

Other systemic symptoms may include:

  • Weakness in the arms and hands

  • Numbness or tingling in the arms and hands

  • Clumsiness and poor coordination of the hands

When should I seek medical help?

There are circumstances when neck pain might be caused or accompanied by serious issues. If such symptoms are present it is best to seek immediate medical attention to avoid further complications.

Although these are rare to encounter, it is always good to make sure you have no worrying symptoms.

  • Pain or stiffness does not go away after a few weeks

  • The pain is disturbing your sleep

  • Painkillers do not work

  • Your pain is caused by a major accident such as a traffic collision or a fall

  • Weakness, numbness, or tingling in your limbs

  • Previous history of cancer

  • If you have a fever, chills, or unexplained weight loss

Diagnosis

The earlier cervical myelopathy is diagnosed, the more successful the treatment is expected to be.

When you go to your doctor, your doctor will ask about your pain symptoms and your past medical history. Then they will perform a physical examination, including palpating the area of pain and checking the range of motion of your neck.

They may also test reflexes in your hands and feet, and check that you have full sensation in all your limbs. Problems with your reflexes or a lack of sensation could indicate nerve damage.

You may be referred for an X-ray, which will show characteristic features of spondylosis, such as the presence of osteophytes (lumps of extra bone). Your doctor may also conduct electrical tests to measure how well the nerves in your arms and hands communicate with your brain through the spinal cord, to visualize if there is any nerve damage.

An MRI may be performed as well. An MRI scan is the imaging method for evaluating radiculopathy as it can visualize the compression of the nerve and soft tissue abnormalities, including herniated disks.

Treatment

In milder cases, initial treatment for cervical myelopathy may be nonsurgical. The goal of nonsurgical treatment is to decrease pain and improve the patient's ability to perform daily activities.

  • Physical therapy. Specific exercises can help relieve pain, strengthen neck muscles, and increase flexibility.

Medications. In some cases, medications can help improve your symptoms.

  • Nonsteroidal anti-inflammatory drugs (NSAIDs). Anti-inflammatory drugs like aspirin, ibuprofen, and naproxen can help relieve pain and reduce inflammation.

  • Narcotics. These medications are reserved for patients with severe pain that is not relieved by other options. Narcotics are usually prescribed for a limited time only.

Although people sometimes turn to chiropractic manipulation for neck and back pain, manipulation should never be used for spinal cord compression.

Surgical Treatment

Cervical myelopathy is generally a surgical condition. To eliminate the compression of the spinal cord and prevent the worsening of the condition, surgery is often necessary.

There are a few surgical procedures your doctor may recommend for treating cervical myelopathy.

Widening of the spinal canal (laminoplasty) can be a good motion-sparing option for some patients. Others may benefit from spine decompression surgery with spinal fusion, which is meant to stabilize the spine after herniated discs, bone spurs or ossified ligaments are fully or partially removed.

Prevention of Cervical myelopathy

You may not be able to prevent cervical myelopathy, but these steps may reduce your risk:

  • Stay physically active

  • Maintain a healthy weight

  • Use good posture. Adjust your desk, chair and computer so that the monitor is at eye level. Knees should be slightly lower than hips

  • Take frequent breaks. If you travel long distances or work long hours at your computer, get up, move around and stretch your neck and shoulders.

  • Prevent neck injuries by always using the right equipment and the right form when exercising or playing sports.

  • Avoid trauma to your neck

  • Avoid carrying heavy bags with straps over your shoulder.

  • Sleep in a healthy position

  • If you smoke, quit. Smoking could accelerate the process of cervical disc degeneration