What is cervical myelopathy? Causes, diagnosis, and treatment

Cervical myelopathy is a serious condition that requires early diagnosis and appropriate treatment to manage symptoms and prevent permanent neurological damage.

Mr Rohit Shetty, renowned consultant orthopaedic and spinal surgeon, provides an expert insight into the condition, addressing causes, diagnosis, and treatment.

What is cervical myelopathy?

Cervical myelopathy is a condition where the spinal cord in the cervical (neck) region of the spine becomes compressed or irritated. This compression affects the spinal cord’s ability to transmit signals between the brain and the rest of the body, causing a range of symptoms.

The most common symptoms of cervical myelopathy include:

• neck pain and stiffness
• numbness or tingling which is typically experienced in the arms, hands, legs, or feet
• muscle weakness in the arms or legs
• difficulties with fine motor skills such as writing
• urinary problems such as urgency or incontinence

What are the causes of cervical myelopathy?

The most common cause of cervical myelopathy is cervical spondylosis, a form of arthritis that affects the neck. As we age, the intervertebral discs and joints in the cervical spine can wear down, leading to bone spurs (osteophytes) that compress the spinal cord.

Other causes of cervical myelopathy include herniated discs, spinal tumours, and traumatic injuries to the neck which can then damage the spinal cord.

How is cervical myelopathy diagnosed?

Your orthopaedic spinal surgeon will begin with a thorough medical history to understand your symptoms and any relevant medical conditions. A physical examination will then evaluate your neurological function, including reflexes, muscle strength, and coordination.

Your orthopaedic spinal surgeon will subsequently conduct various imaging studies:

• MRIs, which provide detailed images of the spinal cord and surrounding structures, helping to identify areas of compression. MRIs are the most definitive test for diagnosing cervical myelopathy.
• X-rays, which show degenerative changes in the cervical spine, such as bone spurs or narrowed disc spaces.
• CT scans, which provide detailed cross-sectional images of the spine and can be useful in assessing bone structures and any bone abnormalities.

Lastly, your orthopaedic spinal surgeon will conduct electromyography and nerve conduction studies to assess your muscle electrical activity and nerve signal speed. These tests can help to determine the extent of nerve damage and differentiate cervical myelopathy from other conditions with similar symptoms.

What treatment options are available for cervical myelopathy?

Treatment for cervical myelopathy depends on the severity of symptoms and the underlying cause. Options range from non-operative measures to surgical interventions.

Non-operative measures

• Medications such as pain relievers, anti-inflammatory drugs, and muscle relaxants to help manage symptoms.
• Physical therapy is commonly recommended as well to focus on strengthening neck muscles, improving posture, and increasing flexibility.

Surgical interventions

Surgery is often recommended if there is significant spinal cord compression or if symptoms are progressing rapidly. Options include:

• Decompressive surgery to remove the structures compressing the spinal cord, such as bone spurs or herniated discs.
• Laminectomy to remove part of the vertebra (the lamina) to help create more space for the spinal cord.
• Spinal fusion to stabilise the spine by fusing two or more vertebrae together.

Can cervical myelopathy be prevented?

While cervical myelopathy may not always be preventable, certain measures can reduce the risk. For example, maintaining good posture minimises the strain on the cervical spine; it’s thus important to practise keeping your head aligned with your spine and avoid slouching.

Regular exercise, particularly those that strengthen neck and back muscles and improve flexibility, can also help to maintain a healthy spine.

Additionally, taking precautions to avoid neck injuries, such as wearing seat belts in cars and using protective gear during sports, is essential. Maintaining a healthy weight and quitting smoking can also help prevent degenerative changes in the spine.

If you would like to schedule an appointment with Mr Rohit Shetty, head on over to his Top Doctors profile today.