Cervical myelopathy is a condition caused due to compression of the spinal canal in the neck region. Or, in a layman’s language, we may say it is a damage caused to the part of the spinal cord that lies in the neck. It often leads to cord dysfunction and affects patients across all age groups. There are many underlying causes for the condition, however among the common ones prevalent are due to spondylosis (called as spondylotic myelopathy) and rheumatoid arthritis.
Usually cervical myelopathy shows no initial symptoms and even if it does they
can be so subtle that the diagnosis may easily be missed or mislead. Also, many a times patients start experiencing neck pain only at the advanced stage which is what makes the diagnosis of the condition difficult.
Apart from spondylosis and rheumatoid arthritis, cervical myelopathy may be caused due to numerous other reasons such as:
*A slipped disc
*Degenerated cervical discs
*Tumors inside the spinal cord
*Compressing on the spinal cord
*Fracture of the neck
*Traumatic injury to the cervical spine
*Autoimmune disease, such as multiple sclerosis, or neuromyelitis optica
*Bone or back problems
*Born with a narrow spinal canal
*History of cancer that involves bones
Common symptoms of cervical myelopathy may depend on factors like the cause of the disease. However, some of the commonly observed symptoms include: difficulty to work with smaller objects, like buttoning up your shirt, muscle weakness and pain in shoulder and arms, changes in handwriting, and tingling or numbness in the arms, etc. Advanced cases may show symptoms like difficulty in walking, increased tripping or imbalance during walking, irregular movements, etc. And, some extreme cases of spinal cord compression may even report feeling of electric shock-like sensations below the waist or arms and problem flexing neck, etc.
In the later stages of the disease, some patients usually complain of weakness in their arms/legs, as well as changes in their bowel habits.
The physical act of compression, or stenosis, may be a result of conditions such as degenerative changes of the cervical spine, known as cervical spondylotic myelopathy. Patients who are born with a smaller spinal canal diameter have a higher propensity to compress the spinalcord when degeneration occurs.
Another condition that results in compression of the cord is known as ossification of the posterior longitudinal ligament (OPLL). In this condition, the ligament in the spinal canal overgrows with abnormal bone, and this in turn causes compression of the spinal cord.
Diagnosis and Treatment
Imaging tests required to diagnose cervical myelopathy and to evaluate the spine and surrounding structures may include:
*CT scans with dye
Other tests may include:
*Somatosensory evoked potentials
*Visual evoked potential test (VEP)
Treatment and Surgical Options
To treat cervical myelopathy it is important to treat the cause of the myelopathy. Based on that your pain can be reduced or managed. Strengthening exercises too help in reliving discomfort and pain. But, if there is any kind of structural pressure being exerted on the spinal cord, you may need an immediate surgery. This is necessary to avoid any further injury. There are different kinds of surgery and procedures recommended to stabilise the neck, such as:
*Discectomy: This surgery requires removal of a part of an intervertebral disc that is exerting pressure on the spinal cord or nerve root.
*Laminectomy: This surgical procedure requires removal of a portion of a vertebra, called the lamina.
*Fusion of the vertebrae. Patients with instability or significant neck pain would probably best benefit form a fusion.
*Cervical Fusion: During this treatment procedure screws and a plate are used to prevent the vertebrae from exerting pressure on the spinalcord.
* Laminoplasty: It’s a newer treatment, in which the spinal canal is enlarged without fusion, with less risk of instability. Laminoplasty is becoming the treatment of choice for many patients with cervical spondylotic myelopathy. However, laminoplasty is not recommended for everyone.
Nonsurgical Approaches and Medication:
Nonsurgical approaches to relieve pain and discomfort may include:
Also, your doctor may prescribe medications such as Nonsteroidal anti-inflammatory drugs among other that may help to relieve symptoms.
Though it is difficult to prevent cervical myelopathy, one can follow these guidelines to prevent any accidents and strains:
*Emphasise on ergonomics like learning correct lifting techniques, improving your posture, and sitting correctly especially while working on laptop, etc.
*Avoid sporting activities if you have had any disc problem in the past.
*Limit neck movement.
*Rise slowly from a seated or laying position.
Dr Satnam Singh Chhabra, Director Neuro Spine Surgery, Sir Gangaram Hospital, New Delhi