Myelopathy

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Myelopathy is a disorder resulting from compression of the spinal cord. It usually develops slowly as a result of aging and associated physical changes, but it can also be acute when the result of trauma. The following sections offer a brief overview of the symptoms, causes, diagnosis, and treatment.

What is Myelopathy?

Myelopathy is damage to the spinal cord in which the spinal cord experiences severe compression or constriction. The spinal cord is the set of nerves that are encased in the bony spine. When the spinal cord is constricted or compressed, the symptoms are called myelopathy.

The spinal cord, or group of nerves, runs along most of the length of the spine. It is the pathway for nerve messages from the brain to the peripheral nervous system. Any damage to the spinal cord is serious.

Since the spinal cord runs the length of the spine, there are three types of myelopathy described by the three sections of the spine.

• Cervical myelopathy – occurs in the cervical spine, which is the neck area
• Thoracic myelopathy – occurs in the middle area of the spine called the thoracic spine
• Lumbar myelopathy – occurs in the lower or lumbar spine

The most common condition is cervical myelopathy. The least common condition is the lumbar myelopathy. Thoracic myelopathy develops most often due to herniated or bulging discs, trauma, or bone spurs.

Symptoms

Myelopathy symptoms vary. Some of the common ones include the following:

• Neck, arm, lower back or leg pain
• Difficulty maintaining balance
• Difficulty with coordination
• Changes in gait or difficulty walking
• Changes in reflexes that may be increased reflexes in extremities or abnormal reflexes
• Reduction in fine motor skills, like grip strength and dexterity
• Changes in bladder or bowel function
• Impingement of nerve roots causes weakness or pain in arms or legs
• Changes in handwriting for no obvious reason

Causes

There are various causes of myelopathy, and many begin with normal aging. The most common myelopathy causes include:

• Rheumatoid arthritis or other autoimmune diseases that lead to spinal degeneration
• Degenerative spinal conditions like spinal stenosis or spondylosis
• Disc herniations
• Diseases like bone cancer and spinal tumors or cysts
• Injury

Though many cases of myelopathy develop slowly, acute myelopathy develops rapidly due to trauma.

When to See a Doctor

It is important to see a doctor when any of the symptoms of myelopathy are present. The sooner the physician is able to identify the spinal cord issue, the better. The spinal cord may have already experienced permanent damage, but there is always the chance that early treatment after symptoms appear can minimize the chances of symptoms worsening.

Diagnosis

The diagnosis of myelopathy is made through a series of exams and tests. It begins with a physician taking a medical history to ascertain whether there are any prior symptoms similar to those associated with myelopathy. This is followed by:

• Physical exam
• Diagnostic tests that include nerve testing like the electromyogram (EMG)
• Imaging tests that may be an MRI, CAT scan, x-rays and myelogram

A myelogram is a type of x-ray called fluoroscopy. Contrast material is injected into the spine to highlight on the x-ray the spinal cord, spinal lining, and nerve roots. It is very useful in situations in which the patient cannot manage an MRI and for assessing spinal disc abnormalities.

Treatment

Myelopathy can lead to paralysis and even death, if left untreated. In most cases, surgery is needed, but the type of surgery depends on the cause of the nerve damage. The usual goal of myelopathy surgery is to relieve the pressure the spinal cord is experiencing.

Other common myelopathy treatment options include:

• Bracing
• Medication
• Physical therapy

These non-surgical treatments do not improve spinal compression. They are intended to help the patient reduce pain.

Myelopathy Prognosis

It is difficult to predict the outcomes for patients with myelopathy. The prognosis is variable because surgical treatments may or may not improve the condition and the symptoms. There is no guarantee the level of pain will improve either. However, the earlier the treatment begins, the more likely permanent spinal cord damage is avoided.