Cervical Myelopathy

General Information


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Myelopathy is a term used to describe symptoms related to spinal cord compression. Cervical myelopathy is most common.

What can cause cervical myelopathy?

Common causes of spinal cord compression are related to degenerative spinal changes such as central spinal stenosis,spondylosis, bone spur formationdisc disease, trauma, or rarely, infection or tumor.  Some patients have a congenital (at birth) narrowing of part of the spinal canal.

While myelopathic symptoms may not present at birth or during childhood, symptoms may begin to develop during adulthood.

Ligaments are important to spinal stability.  However, degenerative changes can cause ligaments to thicken, stiffen, lose tension and become slack.  Most apparent in the cervical spine and during flexion (forward movement) and extension (straighten upright, backward movement); degenerative changes may cause ligaments to shorten during flexion and overlap during extension narrowing the spinal canal and impinging the cord.  Thickening of the ligamentum flavum, a primary spinal ligament, resulting spinal cord compression.

Thickened ligament and subsequent spinal cord compression illustrated

Myelopathy Symptoms

— Problems with coordination; walking, tying a shoe lace, fastening a button

— Difficulty with balance, clumsiness

— Leg spasticity

— General weakness

— Muscle weakness

It is important have to a differential diagnosis due to intraspinal or extraspinal tumors {e.g., Pancoast tumor (associated with Horner syndrome), Schwannomas, lymphomas, esophageal or thyroid tumors, neurofibromatosis, or osteochondromas),  infections (e.g., discitis, tuberculosis, osteomyelitis, or herpes zoster).  Other issues that need to be ruled out, such as meningitis, thoracic outlet syndrome (TOS), cervical spondylotic myelopathy, complex regional pain syndrome, other diseases (e.g., rheumatoid arthritis or carpal tunnel), and referred pain (e.g., cardiac pain). Many of these issues can be eliminated with a thorough history, orthopedic exams, lab work, and images (e.g., x-ray or MRI).

After ruling out red flag issues {e.g., tumor, infection, or signs of myelopathy which may denote degenerative disorder (Carette. 2005)}  nonoperative treatments are most effective for most patients (Eur Spine J. 2011 April; 20(4): 513–522).