Chronic Progressive Myelopathy

Introduction:

The term myelopathy refers to a cluster of symptoms resulting from spinal cord compression, which can occur when the spinal cord becomes compressed by bone fragments due to a spine fracture, abscess, or ruptured disk. Myelopathy results from an injury, neurological deficiency, or inflammation related to the spinal cord. This condition is very progressive, so early recognition and treatment are vital to improving the outcome before the occurrence of irreversible spinal cord damage.

What Are the Causes?

With the progression of age, inflammation, bone spurs, arthritic illness, and flattening of the spinal disks between the vertebrae can pressure the nerve roots and the spinal cords. Chronic progressive myelopathy generally develops gradually due to the gradual degeneration of the spine, called spondylosis. Still, it can also occur in an acute form or stem from a deformity of the spine present at birth.

• Degenerative spinal conditions, such as spinal stenosis (narrowing of the bony passages of the spine through which the nerve roots and the spinal cord travel), are among the most common causes of myelopathy.

• Autoimmune disorders, like rheumatoid arthritis in the spine, can also cause degenerative changes in the vertebrae leading to spinal cord compression and chronic progressive myelopathy.

• Central disk herniations result from compression on the spinal cord and can also cause the development of myelopathy.

• Hernias, hematomas, cysts, and spinal tumors, including bone cancer, may also compress the spinal cord and lead to myelopathy.

• Acute myelopathy can develop rapidly due to a spinal infection, spinal injury, inflammatory disease, neurological disorders, or radiation therapy.

What Are the Symptoms of Chronic Progressive Myelopathy?

The symptoms of myelopathy depend on the condition and nature of the spine. Common symptoms include:

• Weakness, muscle spasms or contractions, and clumsiness.

• Neck, arm, leg, or lower back pain.

• Difficulty with fine motor skills like writing or tying shoes.

• Reflex movement is increased, and abnormal development is noticed.

• In addition, people may suffer from bowel problems, bladder issues, and sexual dysfunction.

What Are the Types of Myelopathy?

There are three types of myelopathy, and they are as follows:

• Cervical Myelopathy: It is a condition that causes spinal cord compression in the cervical spine, which contains seven vertebrae. The neck movement becomes limited and includes symptoms like pain and stiffness. Sharp, shooting pain that starts from the neck and radiates downwards can be experienced.

• Thoracic Myelopathy: The thoracic region is the middle part of the region, and the pain originates from the other part of the spine. It also involves weakness in the arms and legs, loss of bowel, bladder, and sexual functions, and difficulty in walking and maintaining balance. The symptoms of thoracic myelopathy are common and are seen with other types of myelopathy, so testing is required. Testing includes X-rays, nerve function testing, and magnetic resonance imaging (MRI).

• Lumbar Myelopathy: It involves symptoms affecting the lower part of the spine and is much rarer than thoracic and cervical myelopathy. Symptoms are similar to the other two types.

What Is the Diagnosis?

Pain is the most common sign of myelopathy, which includes neck, back, and spine pain. The healthcare provider will recommend specific testing to rule out other conditions and narrow down myelopathy. The test may include the following:

• X-Rays: X-rays are useful for detecting back, neck, and spine problems.

• MRI Scans: Magnetic resonance imaging will offer a detailed look at the spine and the spinal cord and look for inflamed or infected areas.

• Myelography: It is a test done using a combination of X-rays and contrast dye, which helps detect any abnormalities in the spinal cord. Though it can reveal abnormalities in the spinal cord, it is an invasive and risky procedure; and hence is used only when magnetic resonance imaging is not working or cannot be done.

• Electrical Tests: The healthcare provider can see how well the nerves are providing feeling and movement in the arms and legs with the help of a test, such as an electromyogram. These tests assess the nerve movements in the hands, arms, legs, or feet through the spinal cord to the brain.

How Can Chronic Myelopathy Be Treated?

Myelopathy treatment involves reducing pain and improving the quality of life. A non-surgical process might take a long time to achieve this. Still, if followed properly, it can be resolved for a lifetime.

1. Non-surgical Procedure: Many non-surgical treatments are equally effective as surgical treatments to reduce pain and subside the symptoms. This reduces the need for a surgical process if followed properly or at least delays surgery. Non-surgical treatment includes the following:

• Pain Relievers: Mild myelopathy may respond to pain-relieving medications prescribed by the doctors.

• Physical Therapy: Sometimes, bad posture can make one suffer from muscle cramps, leading to muscle pain and weakness in the back and the neck, thereby causing spinal cord compression. This can be relieved by physical therapy, which reduces pain and improves the function. In physical therapy, certain activities and movements that trigger pain in the spinal cord are avoided.

• Steroid Injections: Swelling of the spinal cord can be treated with cortisone injections which is a steroid designed in such a way that it can be used for treatment in the spinal cord. The injection may take days to be effective and should be used sparingly.

2. Surgical Treatment: Three surgeries that are commonly used to treat myelopathy are:

• Spinal Fusion: This surgery can correct problems in the small bones of the spine by fusing two or more vertebrae so that they fit into a single solid bone.

• Laminectomy: In this procedure, the bony arch of the spinal canal called the lamina is removed. This procedure enlarges the spinal canal to relieve pressure and provides space to shift back.

• Laminoplasty: It is an alternative to laminectomy in which the lamina is thinned out on one side and then cut on the other, thereby expanding the space of the spinal cord.

Conclusion:

Neck and back pain are common problems experienced by most people. Sometimes pain can exaggerate to an intolerable level. Such cases can be managed with certain treatments. People should talk to their healthcare provider if they experience pins and needles in their arms and legs. It can be treated well but can take a long time.