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Cervical Myelopathy

Cervical Myelopathy

Cervical myelopathy is a rare condition that results from compression of the spinal cord in the neck. The spinal cord controls all of the signals for all the nerves in the body and thus compression of the spinal cord may prevent the nerves from functioning normally. This condition is often hard to diagnose and may lead to many unnecessary tests and procedures being performed. It is important to diagnose cervical myelopathy early and treat it adequately to prevent further neurological deterioration and to save any chances of recovering neurological functions.

Most commonly seen in patients over the age of 50, cervical myelopathy is the result of arthritis in the front and/or the back of the spine resulting in compression of the spinal cord as it is traveling through the neck. Most commonly this can be seen before the patient develops obvious symptoms on a physical examination by series of provocative tests. These tests would indicate that the patient has abnormal spinal cord function and an MRI could be performed to determine the degree of spinal cord compression. If it is not diagnosed early, the patient can then progress to developing symptoms and treatment at that time may not reverse the damage has already been done.

The most common complaint the patients have when they are seeing a physician for possible cervical myelopathy is that they are having trouble walking. Most patients describe the feeling is that their gait has become 'uncoordinated' and/or that their legs feel 'very heavy'. On examination it is clear this patient has problems of balance and coordinated walking. Physical examination will also likely show abnormal reflexes and possible abnormal strength in the lower and - possibly upper - extremities. Some patients may also have pain radiating into the arms, leading to a condition known as cervical myeloradiculopathy.  The most important tools that a physician has in making the diagnosis of cervical myelopathy is the clinical examination and an MRI. If the patient is unable to get an MRI then a CT myelogram could be performed to assess the location and degree of spinal cord compression.

The treatment of cervical myelopathy depends on the degree of severity of the clinical condition. If the patient has no clinical symptoms and the findings are just on the physical examination and/or the imaging, the patient may be observed for a period of time. Typically I would recommend biannual or annual examination and MRIs. If the patient is developing symptoms, then surgery is recommended. Surgery is performed to decompress the spinal cord, but this also often involves stabilizing the cervical spine. There are many details regarding which surgery is appropriate for each individual depending on how many levels of stenosis are present. The goal of surgery in cervical myelopathy is to prevent the patient from getting worse; if the patient regains any lost neurological function, then this would be a pleasant but unexpected surprise.

Cervical myelopathy is rare and can come in a variety of manifestations thus it is very important that each case is discussed individually with an orthopedic spine surgeon to confirm the diagnosis, to determine if surgery is necessary, and - if surgery is necessary -what is the optimal surgery that should be performed. Please discuss your particular situation with a board certified orthopedic spine surgeon.