Cervical Myelopathy

Cervical Myelopathy

What is Cervical Myelopathy?

Cervical myelopathy refers to a clinical condition that affects the cervical part of the spinal cord. Unlike conditions that affect the individual nerve fibers, cervical myelopathy involves compression of the entire spinal cord with resultant damage to and loss of function of all the nerves that lie below the level of compression in the cervical portion of the spine.

What Causes Cervical Myelopathy?

Cervical myelopathy occurs due to compression of the cervical portion of the spinal cord. Different pathologies can compress the spinal cord and can include a protruded intervertebral disc (disc herniation), bone spur formation due to osteoarthritis and compression of the spinal column from tumors. Other causes are relatively rare and can include infections, inflammatory conditions, nutritional disorders and injury to the spinal column.

Whatever the cause, the underlying pathology is always one of compression of the spinal cord due to narrowing of the space within which it lies. In other words, spinal stenosis seems to be the underlying pathology.

Symptoms and Signs

The clinical symptoms and signs seen in cervical myelopathy depend upon where exactly the compression is occurring. In patients who havecompression near the cervical vertebra, there may be weakness and altered tone within the muscles of the upper limb and lower limb. Patients may experience bowel and bladder incontinence along with an alteration in skin sensation. On clinical examination, the deep tendon reflexes (the reflexes that are elicited when a doctor taps various tendons in the body gently with a rubber hammer) may be exaggerated.

In patients who have myelopathy that has occurred due to compression at a lower level (thoracic and lumbar), the symptoms may only involve legs and patients may experience difficulty walking, complete paralysis and alteration in sensation.

Whatever the level of compression is, it is essential to diagnose this quickly and treat it as an emergency.

Diagnosis of Cervical Myelopathy

 

Most cases of cervical myelopathy can be diagnosed from clinical examination. The neurological deficits that can be elicited from examination can help ascertain the level at which the myelopathy has originated. This can help decide on treatment. Additional investigations will be performed and can include a CT scan or MRI scan.

The cause of cervical myelopathy can be fairly easily deduced from history. In patients who have a slow onset and gradual progression of symptoms, it is likely that the compression is caused due to an abnormal blood vessel (called arteriovenous malformation) or an accumulation of blood around the spinal cord. Patients who also experience pain from individual nerve fibers (called radiculopathy) are likely to have an infection or tumor that is affecting the spinal cord.

Treatment

The treatment of cervical myelopathy depends upon the cause. It is considered an emergency and the pressure that is being placed upon the spinal-cord must be relieved as soon as possible. Depending upon the cause, different treatments may be offered. Surgery appears to be the mainstay of treatment. Patients who experience constant pain will require painkillers. Regular over-the-counter medication may help but in some cases patients require morphine-based painkillers.

Cervical Spinal Stenosis

Cervical Spinal Stenosis

Overview and Causes

Cervical spinal stenosis is a condition that refers to narrowing of the spinal canal in the cervical area of the spine, typically caused by age and degeneration of intervertebral discs and facet joints. Arthritis is the most common cause of cervical spinal stenosis, as it causes facet joints to expand, leaving little room for nerve roots. As the disc degenerates, they dry out and weaken, reducing in height. The load on the vertebrae shifts, putting more demand on the facet joints. The facet joints can weaken and inflame, causing the openings to shrink and press on nerves. Bone spurs may also develop and grow into the spinal canal. Ligaments around the joints can also increase in size, causing additional irritation and pressure on nerves.

Symptoms and Diagnosis

Many of the symptoms of cervical spinal stenosis are consistent with other spinal conditions:

Neck and Back Pain – This may or may not occur and many people with cervical spinal stenosis feel pain in their extremities (arms and legs) rather than in their neck or back. This is known as “referred” pain.

Numbness/Tingling – The pressure on nerves may cause sensations in extremities that feels like an electric current or a lack of sensation in touch. Burning/Aching Pain – Nerve pressure can cause a radiating pain down the extremities. This is often referred to as sciatica. This pain can extend its reach based on location of degenerative condition.

Weakness/Instability – As pressure on nerves increase, the extremities can lose strength and ability to maintain grip or balance. Cervical spinal stenosis causes weakness in hands and grip. Lumbar Spinal Stenosis can cause “foot drop,” where the patient’s foot drops or drags while walking.

Your doctor may perform tests on you to determine if you have Cervical spinal stenosis, and how severe it is. These tests may include patient history, X-rays and MRIs to get background and images of your spine. Additional tests may include CT scans and myelograms to determine where the condition is occurring and if nerves are being compressed.

Treatment

Treatment for cervical spinal stenosis ranges from conservative to surgical. Your doctor will work with you to develop the most effective treatment path. Non-surgical options include physical therapy, lumbar stabilization and traction devices, anti-inflammatory medications, steroidal injections and/or other non-surgical treatments. Surgical options range and are decompressive in nature. The surgical options depend on severity of condition and may or may not include discectomy, or removal of damaged disc. Discuss your options with your doctor.

Diagnosis of Cervical Myelopathy

 

Most cases of cervical myelopathy can be diagnosed from clinical examination. The neurological deficits that can be elicited from examination can help ascertain the level at which the myelopathy has originated. This can help decide on treatment. Additional investigations will be performed and can include a CT scan or MRI scan.

The cause of cervical myelopathy can be fairly easily deduced from history. In patients who have a slow onset and gradual progression of symptoms, it is likely that the compression is caused due to an abnormal blood vessel (called arteriovenous malformation) or an accumulation of blood around the spinal cord. Patients who also experience pain from individual nerve fibers (called radiculopathy) are likely to have an infection or tumor that is affecting the spinal cord.

Treatment

The treatment of cervical myelopathy depends upon the cause. It is considered an emergency and the pressure that is being placed upon the spinal-cord must be relieved as soon as possible. Depending upon the cause, different treatments may be offered. Surgery appears to be the mainstay of treatment. Patients who experience constant pain will require painkillers. Regular over-the-counter medication may help but in some cases patients require morphine-based painkillers.

Risks and Benefits

Failure to take preventive measures for any spinal condition may result in a further aggravated condition. Surgical measures for advanced cases may give relief from extremity pain. The risks involved with surgery are common – infection, blood loss, damage to nerves and spine – and some specific to your treatment. Always consult with your doctor about the particular risks and benefits of your treatment.

Did you Know?

4 out of 5 second opinions result in a new or refined diagnosis

Did you Know?

4 out of 5 second opinions result in a new or refined diagnosis

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