Myelopathy

Myelopathy is simply defined as a compression of the spinal cord. The spinal cord is a long, tubular bundle of nerves that serves as a pathway of communication signals between your brain and your body. It is located inside your spinal canal that runs almost its entire length. Your spine, also termed as the vertebrae, functions as protection of your spinal cord.

Conditions

Signs & Symptoms of Myelopathy

Myelopathy has wide range of signs and symptoms. The pressure on the nerves can cause problems on almost any part of your body. Myelopathy results from compression of the spinal cord may cause weakness of the hands and/or legs, problems with walking, balance, and coordination. Loss of normal bowel, bladder, or sexual function may develop. The condition is often painless, unless accompanied by radiculopathy, which is compression of a nerve root, which may cause radiating pain.

The signs and symptoms depend on which part of your spinal cord is compressed. If it’s at the back of your neck (called your cervical area), you may have problems such as numbness, tingling sensations, weakness, or pain. You may feel them just below the area where the compression is. It can start from your neck, to your shoulders, extending to your upper extremities. It can also radiate to your legs or feet depending on the severity of the nerve compression.

Myelopathy at the lower portion of the spine can cause pain, weakness, numbness or tingling, and cramping in your lower extremities.

Myelopathy can also cause problems with balance, walking, and running. It can also produce bladder and bowels problems.

Description of Myelopathy

Myelopathy is defined as abnormal function of the spinal cord.  

It has many causes:

  • spinal cord compression due to herniated disc, bone spur, etc.
  • bleeding/vascular malformation
  • tumor or cyst
  • abscess or infection
  • autoimmune diseases/multiple sclerosis
  • trauma
  • spinal deformity (kyphosis, spondylolisthesis)

Myelopathy is a concerning condition because it can result in loss of the use of hands or the ability to walk if left untreated. Once spinal cord damage occurs, it is often not fully reversible. Myelopathy can arise at any level of the spinal cord but most commonly arises from a problem in the neck. The usual time course for symptoms of myelopathy is a gradual onset and slow progression over months and years. Myelopathy more commonly affects adults age 50 and older.

Types of Myelopathy

The types of myelopathy are named depending on the area of the compression.

  • Cervical Myelopathy

Cervical myelopathy occurs at the top of the spine (at the back of your neck) and is the most common type of myelopathy. Pain on the neck is one of the most common symptoms of this type of myelopathy. Other patients complain shoulder pain and discomfort.

  • Thoracic Myelopathy

Thoracic myelopathy occurs in the middle section of your vertebrae. The spinal cord on this region typically gets compressed due to problems at the spine such as bulging or protrusion of the discs, herniation, subluxation, or a spinal trauma.

  • Lumbar Myelopathy

Lumbar myelopathy occurs at the lower portion of the spine. It is a rare condition since the spinal cord ends just before lumbar spine’s top section. However, on some individuals with a low-lying or tethered spinal cord, lumbar myelopathy can occur.

Causes of Myelopathy

Myelopathy happens when something presses against the spinal cord secondary to any trauma, spinal subluxation or misalignment, as well as degenerative diseases, and other factors that may contribute to compression or constriction of your nerve bundle. Other causes may also include the following:

  • Infections along the spine
  • Tumors
  • Inflammation
  • Autoimmune disorders
  • Spinal stenosis or narrowing of the spine surrounding the nerves
  • Musculoskeletal problems such as arthritis
  • Congenital disorders

Myelopathy develops slowly, and the factors that can contribute to this condition can be anything that results into a reduction of the space of your spinal canal (which houses your spinal cord) including the normal wear and tear of everyday life. It can be triggered by an injury to your neck or to any area of your back. It can also be an effect of other diseases such as arthritis or a tumor pressing the spinal cord.

FAQ

The natural onset and time course for myelopathy is usually a slow onset and gradual progression over time.  It would typically take months to years for symptoms to progress to a total loss of function.  However, more rapid deterioration can occur, and it is most appropriate to be followed closely by a spinal surgeon (Orthopaedic spine speacialist or a Neurosurgeon) if you have this condition.

Myelopathy most commonly comes from compression of the spinal cord due to degenerative arthritis of the spine.  There are also many other possible causes that need to be evaluated by your physician.

Myelopathy is commonly treated with surgery to stop progression of symptoms and allow the spinal cord the best chance to heal and recover.  However, not every patient with myelopathy is an appropriate candidate for surgery.  Each individual should have his or her own case reviewed by a spinal surgeon with experience treating this condition.

Myelopathy

Treatment Options

Treatment options depend on the presenting signs and symptoms. You may benefit from prescription medications or from physical therapy. If myelopathy doesn’t respond to these non-invasive treatment options, your doctor may recommend surgery to relieve the spinal cord compression.

Treatment for myelopathy is based upon the underlying cause. Physical therapy and observation over time can be recommended in mild cases. Tumors and bleeding are often treated with surgical removal for diagnosis and treatment. Multiple sclerosis and inflammatory disorders are generally treated with immune suppression.

Spinal cord compression may need to be treated surgically from the front (anterior), the back (posterior), or both.

Anterior decompression includes removal of disc (discectomy) or removal of the vertebral body (corpectomy).  These procedures are accompanied by either fusion or artificial disc replacement.

Posterior decompression includes removal of the lamina (roof of the spinal canal), also known as a laminectomy. This procedure may be accompanied by fusion with screws and rods.  Widening of the spinal canal is also sometimes possible without complete removal of the lamina.  This is known as laminoplasty.

Minimally invasive options for decompression and fusion are often available. The best treatment options for you or your loved ones should be discussed in detail with a spinal surgeon.

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