Cervical Myelopathy

1. What is Cervical Myelopathy?

Cervical myelopathy is a condition where the spinal cord in the neck becomes compressed, leading to neurological symptoms. Unlike a pinched nerve (radiculopathy), this condition affects the spinal cord itself, which can impact balance, coordination, and even fine motor skills. It is the most common cause of spinal cord dysfunction in adults.

2. Causes

Cervical myelopathy typically develops from conditions that narrow the spinal canal, including:

• Cervical Stenosis: Progressive narrowing of the spinal canal

• Degenerative Disc Disease: Disc height loss and bulging that compress the cord

• Bone Spurs (Osteophytes): Overgrowth of bone due to arthritis

• Herniated Discs: Disc material pressing on the spinal cord

• Thickened Ligaments: Age-related changes in spinal ligaments

• Trauma or Injury: Fractures or dislocations that reduce space for the cord

• Congenital Stenosis: Being born with a naturally narrow spinal canal

3. Symptoms

Cervical myelopathy often develops gradually, but symptoms can worsen over time:

• Neck pain and stiffness

• Tingling, numbness, or weakness in the arms and hands

• Loss of fine motor control (difficulty buttoning clothes, writing, or grasping objects)

• Problems with balance or frequent falls

• Leg weakness or stiffness when walking

4. Diagnosis

Cervical myelopathy is diagnosed through:

• Medical history and physical exam: Evaluating strength, reflexes, coordination, and gait

• Imaging studies: MRI is the most useful test to show spinal cord compression; CT scans and X-rays may also help assess bone spurs

• Neurological testing: Nerve studies may be used if symptoms are unclear

Because cervical myelopathy can cause permanent nerve damage, early and accurate diagnosis is critical.

5. Treatments

Non-Surgical Options:
While medications, physical therapy, and activity modifications may temporarily relieve symptoms, non-surgical treatments rarely stop the progression of cervical myelopathy once the spinal cord is compressed.

Minimally Invasive Spine Surgery Options:
The most effective treatment for cervical myelopathy is surgical decompression to relieve pressure on the spinal cord. When appropriate, minimally invasive spine surgery can achieve this through smaller incisions with less muscle disruption, shorter hospital stays, and faster recovery. Procedures such as cervical laminoplasty can relieve spinal cord pressure while preserving motion and stability.

Other Surgical Options:

• Anterior Cervical Discectomy and Fusion (ACDF): A common surgery to remove the disc that is causing stenosis and stabilize the spine

• Posterior cervical decompression and fusion: Used in more severe cases requiring spinal realignment or severe instability