Myelopathy: everything you need to know

Myelopathy is a spinal cord disorder characterised by damage or compression leading to symptoms like weakness, numbness, and coordination issues. It can result from injury, degeneration, or diseases like multiple sclerosis. Leading consultant spinal surgeon Mr Ramsey Chammaa discusses the condition, including symptoms, causes and treatment options.

What is myelopathy?

Myelopathy refers to any disorder affecting the spinal cord, which extends from the base of the brain through the cervical thoracic spine to around the first and second lumbar vertebrae, resembling a horse's tail, known as the cauda equina.

Myleopathy can be caused by various factors, such as trauma, spinal fractures or dislocations, infections leading to bone destruction or pus accumulation exerting pressure on the spinal cord, tumors causing compression, and degenerative conditions like cervical spondylotic myelopathy. The latter, characterised by wear and tear, results in spinal cord compression, impacting functions below the affected area.

What symptoms do patients usually experience?

Essentially, patients often aren't aware they have myelopathy; they're typically referred to me for other concerns, and that's when I detect it. Alternatively, they may exhibit various symptoms prompting an MRI scan, which reveals spinal cord compression, leading them to seek my consultation. Key inquiries I make include assessing hand function because compression in the spinal cord primarily affects the hands. I inquire if they experience clumsiness, as tasks like buttoning or zipping become challenging due to decreased dexterity. Consequently, they may opt for button-less or zip-less clothing or slip-on shoes to avoid tying laces. Additionally, they might struggle with precise finger movements and prefer using their palms to push objects rather than using a pincer grip.

They'll probably attribute it to ageing or arthritis, but in reality, they may not realise the underlying cause, which I identify. Another notable change can be seen in their handwriting. While arm pain may not always be present, walking is significantly impacted by myelopathy, whether it's due to neck or chest compression. Patients may describe feeling unsteady or unable to walk in a straight line, especially noticeable when navigating in the dark or during nocturnal trips to the bathroom. Some even resort to cushioning furniture to prevent falls. These symptoms aren't always volunteered by patients but require careful elicitation. Lastly, control over bowel movements becomes an important aspect to consider, gauging their awareness of when they need to use the restroom.

What causes myelopathy?

The causes of myelopathy encompass anything that leads to spinal cord compression or dysfunction, including inflammatory conditions like multiple sclerosis. Factors such as inflammation, infection, cancer, degeneration, trauma, and even surgical interventions can contribute. During surgical procedures, spinal cord monitoring provides real-time nerve status updates. Diagnosis often necessitates a multidisciplinary team involving radiologists and neurologists to tailor treatments to individual patients.

How serious is myelopathy?

The situation can be quite serious. When an MRI confirms pressure on the spinal cord and examination findings align, surgery is typically recommended. Left untreated, confirmed myelopathy almost certainly leads to deterioration, although the timing and extent are uncertain. Intervention aims to halt further decline and preserve neurological function, including dexterity, balance, gait, and bowel control. While some patients may decline treatment and experience worsening weakness and dependency, the majority can stabilise or improve with intervention.

How is myelopathy treated? Can it be cured?

The appropriate treatment for myelopathy depends on its underlying cause. For infections, antibiotics and possibly surgery are utilised. Fractures require realignment and stabilisation. Tumors require consultation with specialised centres for interventions like surgery, radiotherapy, or chemotherapy.

In cases of degenerative myelopathy, treatment is personalised. If a patient shows no symptoms or abnormal neurological findings despite MRI evidence of pressure on the spinal cord, surgery may not be recommended. However, individual functionality plays a crucial role. For instance, if a patient engages in high-risk activities like boxing or paragliding, surgery may be advised to prevent potential spinal cord injury. Conversely, elderly or frail patients with low functional demands may face greater risks from surgery than benefits.

Although some patients may have lived with myelopathy for years, detection remains vital. Treatment must be tailored to each patient, acknowledging their unique circumstances. While treatment can mitigate further deterioration, functional recovery isn't guaranteed and may take years to manifest.

If you would like to book a consultation with Mr Chamma, simply visit his Top Doctors profile today.