Cervical Myelopathy - Causes, Progression of Symptoms, Diagnosis, and Treatment

What Is Cervical Myelopathy?

It is a neurological condition involving compression of the spinal cord within the spinal column around the neck area. The spinal cord emerges from the base of the brain and lies protected inside the spinal column. It is cushioned by rubbery disc-like structures between the vertebrae (intervertebral discs) and the cerebrospinal fluid (CSF) freely flowing inside the spinal canal. Physical injuries and wear and tear to these structures compress the spinal cord and cause cervical myelopathy. One suffers neck and arm pain along with dysfunction of the spinal cord due to this condition.

What Are the Causes of Cervical Myelopathy?

The spinal cord stays suspended in cerebrospinal fluid, which provides the required nutrients and keeps it healthy. Due to aging and other reasons, people may have the disc (intervertebral discs) bulging. The bulging portion crosses the spinal fluid and compresses the spinal cord in more than one area. In some individuals, the bulging disc may get calcified and turn into a bony structure, making it even more dangerous. Additionally, some may suffer ligament thickening in the back of the spinal cord as well. Cervical myelopathy is caused by a compression of the spinal cord by narrowing of the spinal canal (stenosis).

Between disc bulging and ligament thickening, there is a significant decrease in space inside the spinal canal for the spinal cord to exist. Ultimately, this compression becomes so severe that the spinal cord may swell up. So, when the brain tries to send signals down to the hands and feet, it gets slowed down in the area, just like in a traffic jam. This is when the cervical myelopathy symptoms progress. Some of the other causes resulting in cervical myelopathy are:

• Spinal infections.

• Rheumatoid arthritis of the neck.

• Tumors and cancers on the spine.

• Trauma or whiplash injury to the spine.

What Are the Symptoms of Cervical Myelopathy?

Cervical myelopathy has a stepwise progression. The functional decline may happen all of a sudden; then, the individual may improve and get a little better for a while. But declines suddenly again, and it keeps recurring. The time period for the improvement phase cannot be predicted; it could be a matter of months or a matter of years. Those with mild signs do see some sort of worsening of symptoms as time goes on. Often, the severity is related to the amount of physical compression of the spinal cord. The subtle initial symptoms may go unnoticed. But as time goes by, they tend to worsen. People describe the progress of symptoms as:

1. Neck Symptoms - Pain and stiffness in the neck, reduced range of motion.

2. Balance Issues - Over the course of three to six months, a normal walking individual may have to depend on a cane, then a walker, and eventually a wheelchair due to a quick progression.

3. Diminished Hand Dexterity - Meaning problems doing fine motor tasks with the fingers, such as buttoning up a shirt or wearing jewelry, or picking up coins off a table. One suffers poor coordination and clumsiness while attempting such tasks.

4. Strength Loss - Eventually, one may experience weakness in the legs or hands. Accompanied by sensory loss, numbness, and tingling in the hands, feet, or both.

5. Functional Decline - As time goes on, some individuals may need assistance for activities of daily living due to a major functional decline.

How Is Cervical Myelopathy Diagnosed?

Diagnosis involves the following tests:

• A thorough physical examination to evaluate the strength, coordination, and reflexes of different body parts. The doctor may evaluate the functional ability of each muscle group in the body. Also, using different stimulations one’s ability to perceive feeling like touch, pressure, pain, vibration, heat, and cold are tested to determine if the sensations are correctly carried to the brain. Apart from this, the doctor will look for certain reflexes, by evaluating body's response on tapping certain parts of the body with a rubber hammer.

• A magnetic resonance imaging (MRI) of the neck to see the extent of compression and the amount of area involved. Occasionally, some have myelopathy at the mid-back as well because the spinal cord extends to the bottom of the ribcage. In an MRI, a white area inside the spinal cord shows swelling and damage. An x-ray or computed tomography (CT) myelogram of the neck are additional imaging studies used for diagnosis.

• Nerve conduction studies measure the strength of electrical signals passed on from the nerves to the muscles.

How Is Cervical Myelopathy Treated?

No medications can fix the structural problem of the spine, and the recovery depends on how severe the symptoms were earlier. Close follow-up is very crucial if one has symptoms of cervical myelopathy. Serial physical exams or timely check-ups should be done to figure out if the symptoms are stable or worsening. If they worsen over time, one may consider quick surgical treatment. The choice of treatments are:

1. Early surgical treatment on worsening of symptoms or if symptoms start in a very severe mode. The goal of surgery is to create more space inside the spinal canal. Thereby decompressing the spinal cord and opening up the traffic jam, and allowing proper transmission of signals from the brain to different parts of the body. Another goal is to halt the further progression of symptoms. One may conduct the procedures known as anterior cervical discectomy and fusion or posterior cervical discectomy. Cervical laminoplasty or motion sparing and posterior cervical laminectomy and fusion are also preferred.

2. Physical therapy can be tried to improve balance and coordination, but the progression of cervical myelopathy cannot be changed with therapy. Wearing a cervical collar brace may help too.

Conclusion:

The only available treatment for cervical myelopathy currently is surgical decompression of the spinal cord. One may be able to pause the symptoms the way they are at the time of surgery so that it does not worsen with time. With time, a few of the affected individuals have shown improvement in symptoms. They were younger patients in the early stages of the disease who were non-diabetic and non-smokers. Identifying the symptoms early with the help of a qualified medical professional is the first step to achieving the best outcomes.