What Is Cervical Myelopathy?
Cervical myelopathy refers to a constellation of signs and symptoms seen when there is spinal cord compression in the neck. Because patients may only show subtle neurologic changes early on, the diagnosis can be easily missed. Early recognition and treatment is essential for optimal outcome before the onset of irreversible spinal cord damage.
Cervical myelopathy is due to compression (stenosis) of the spinal cord in the neck. The most common cause is arthritis of the cervical spine (spondylosis). As the spine ages, disc herniations or bulges along with bone spurs can push into the spinal canal and press against the spinal cord. Some patients are born with smaller spinal canal (congenital spinal stenosis) and they have a higher propensity for cervical myelopathy as the spine degenerates with age. Ossification of the posterior longitudinal ligament (OPLL) is another condition that can cause cervical myelopathy. In this condition, one of the ligaments in the spinal canal turns into bone and squeezes the spinal cord. OPLL is more common in Asians.
Signs and Symptoms
Patients present to the doctor’s office with a variety of symptoms. There may be a generalized feeling of clumsiness in the arms and hands. Patients often complain of dropping objects like coins or having difficulty buttoning shirts. There may be numbness or weakness. If the spinal cord compression is more severe, patients will have increasing difficulty walking and will notice more tripping and falling as if drunk. Along with gait disturbance, there may be weakness in the arms and legs and changes in bowel and bladder habits. Many patients surprisingly do not have any neck pain, and this is why cervical myelopathy is often diagnosed late.
Diagnosis
Dr. Cho will conduct a thorough history and physical examination during your initial visit. Abnormal reflexes or subtle changes in sensation and strength may warrant further investigation. X-rays can show arthritic changes such as bone spurs. More advanced studies like MRI and CT scans with dye can confirm spinal cord compression.
Non-surgical Treatment
Symptomatic myelopathy is a progressive disease that can result in irreversible damage to the spinal cord if left alone. Thus, cervical myelopathy is generally best treated with surgery.
Surgical Treatment
Surgery can improve patient’s functional outcome, decrease pain, and prevent further deterioration of neurologic status. The goal of operative treatment for cervical myelopathy is to relieve the pressure off the spinal cord. Dr. Cho will offer the type of procedure that is best suited for each patient. The spine can be approached from either the front (anterior) or the back (posterior) of the neck. Anterior cervical discectomy and fusion is a highly effective procedure with excellent success rate. Motion-preserving procedures such as laminoplasty or artificial disc replacement may be offered as an alternative.
- Anterior Cervical Discectomy and Fusion
- Artificial Cervical Disc Replacement
- Cervical Laminoplasty
- Posterior Cervical Laminectomy and Instrumented Fusion