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Myelopathy - Types, Causes, Symptoms, Diagnosis, and Treatment

Published on Aug 12, 2022   -  5 min read

Abstract

Myelopathy is a term used to describe a group of conditions caused by severe spinal compression. Read the article below to learn more about this.

What Is Myelopathy?

Myelopathy is a term that describes a group of symptoms caused by spinal cord compression. Myelopathy is the result of a spinal cord injury, neurological difficulties, or inflammatory disorder. This can happen when bone fragments from a spine fracture, abscess, or ruptured disc compress the spinal cord. The spinal cord cannot operate correctly when it is compressed (squeezed). This can result in pain, numbness, or trouble moving certain body parts. Depending on the section of the spine that is afflicted, myelopathy can be classified as cervical, thoracic, or lumbar.

Clinically Relevant Anatomy for the Condition

The spinal cord is a very critical component of the central nervous system, and even a minor injury can result in a significant disability. The spinal cord extends from the cranium and forms the central nervous system along with the brain. There are eight cervical nerve roots and seven cervical vertebrae. The spinal cord begins at the foramen magnum and is encased by the vertebral column. The cervical spine is stabilized and protected by a complex system of ligaments.

What Are the Various Types of Myelopathy?

Myelopathy can affect any part of the spine and is given a different term depending on where it occurs.

  • Cervical Myelopathy - Cervical myelopathy is a condition in which the spinal cord is compressed in the area of the cervical spine (neck). The cervical spine is composed of seven vertebrae (C1 through C7), six vertebral discs, and eight nerve roots. Cervical myelopathy is known to generate two types of symptoms: neck symptoms and symptoms that arise all over the body at or below the compressed location in the spinal cord. Neck discomfort and stiffness, as well as a decreased range of motion, are common symptoms. A person may suffer shooting pain in the neck that travels down the spine as the illness progresses.

  • Thoracic Myelopathy - The thoracic area is the spine's middle section. A bulging or herniated bone spurs, disc, or spinal trauma can all induce thoracic myelopathy, which compresses the spinal cord in this area. The location of the myelopathy is designated as thoracic myelopathy. Even if the myelopathy starts in the thoracic region, discomfort can spread to other sections of the spine.

Myelopathy can also be categorized based on the symptoms it generates or the underlying causes of the ailment. These are:

  • Vascular origin myelopathyis characterized by a disruption in the blood supply to the spinal cord. Any compressive or non-compressive condition might influence the blood flow to the spinal cord. Symptoms are comparable to those of other myelopathies, particularly those affecting the nervous system. The best chance for neurological recovery is early detection and therapy.

  • Significant trauma is frequently the cause of post-traumatic compressive myelopathy. According to research, the majority of injuries are caused by car accidents, violence, falls from great heights, and sports injuries. Men are more likely to develop these myelopathies, which can result in swelling and internal bleeding.

  • Spinal epidural abscesses are common in the thoracic and lumbar spine areas. If left untreated, abscess-related compressive myelopathy can take shape quickly. Infections or the use of medical tools are the most common causes. In many of these cases, there is no clear cause. Severe back pain, discomfort in the affected areas, and a fever are all symptoms. Neurological symptoms such as saddle anesthesia (lack of sensation in the buttocks, perineum, and inner surfaces of the thighs), limb paralysis, and bladder and bowel issues may develop if the abscess compresses the spinal cord.

What Are the Causes of Myelopathy?

Inflammation, arthritic disease, bone spurs, and flattening of the spinal discs between the vertebrae can exert pressure on the nerve roots and the spinal cord as one gets older. Myelopathy usually develops over time as a result of the gradual degeneration of the spine (spondylosis), although it can also occur suddenly or be caused by a congenital defect.

  • Degenerative spinal disorders such as spinal stenosis, a narrowing of the bone pathways through which the spinal cord and nerve roots travel, are common causes of myelopathy.

  • Rheumatoid arthritis in the spine, an autoimmune condition, can cause degenerative changes in the vertebrae, resulting in compression of the spinal cord and myelopathy.

  • Myelopathy can develop as a result of central disc herniations because the spinal cord is compressed. Myelopathy can be caused by hernias, cysts, hematomas, and spinal tumors, including bone cancer, pressing on the spinal cord.

  • As a result of a spinal injury, infection, inflammatory disease, radiation therapy, or neurological diseases, acute myelopathy can develop.

What Are the Symptoms of Myelopathy?

The nerves that regulate many of your body's actions and functions are affected by spinal cord compression. Different sections of the spinal cord control distinct functions. Myelopathy symptoms differ depending on which section of the spinal cord is afflicted.

  • Neck, back, arm, or leg pain.

  • Fine motor skills difficulties, such as buttoning a shirt or gripping small objects.

  • Remarkably increased reflexes in the peripheral extremities or the emergence of aberrant reflexes.

  • Struggle with walking along with issues in balance and coordination.

  • Numbness, tingling sensation, and weakness in the limbs.

  • Bowel and bladder control are lost.

How Is Myelopathy Diagnosed?

Myelopathy's most prevalent symptoms are not unique to this disorder, and they can be misdiagnosed as other illnesses. The healthcare professionals will conduct a comprehensive physical exam and order tests to diagnose myelopathy appropriately. These tests may involve the following:

  • Imaging tests include an X-ray or a computerized tomography (CT) scan.

  • A magnetic resonance imaging (MRI) scan of the spine and spinal canal can reveal areas of stenosis.

  • An electromyogram (EMG) or somatosensory evoked potentials are electrical tests that demonstrate how well your nerves are working to supply feeling and movement to your arms and legs. These tests determine how nerve stimulation in the hand, arm, leg, or foot connects to the brain via the spinal cord.

  • For patients who are unable to enter an MRI scanner, myelography is utilized instead. In order to show problems in the spinal cord, myelography employs a contrast substance and a real-time form of X-ray called fluoroscopy.

What Is the Treatment and Management of Myelopathy?

Treatment for myelopathy is based on the underlying causes. However, in certain circumstances, the reason may be permanent, and treatment may only be able to assist one in managing the symptoms or slow the disorder's course.

A. Nonsurgical Treatment - Bracing, physical therapy, and medicine may be used as nonsurgical treatments for myelopathy. These therapies are intended to relieve discomfort and assist the patient in returning to their daily activities if they have mild myelopathy. The compression is not relieved by nonsurgical therapy. The symptoms will worsen over time, and this usually takes place gradually and occasionally might be abrupt. If the symptoms are getting worse, see the doctor as soon as possible. Even with treatment, some of the progression can be irreversible, which is why it is critical to halt any progression when it is detected in its early stages.

B. Surgical Treatment - Surgeons perform spinal decompression surgery to relieve pressure on the spinal cord caused by a herniated disc, cyst, bone spur, or tumor. Decompression surgery, such as a laminectomy, is a process where a surgeon removes tiny bones from the spine. The space around the spinal cord is increased by removing the bones. While one waits for surgery, one can manage the pain with a combination of exercise, lifestyle changes, hot and cold therapies, injections, or oral medicine. It is critical to follow the doctor's instructions for taking any medications, as many pain relievers and muscle relaxants can have adverse effects if used for an extended period of time.

Conclusion:

Myelopathy might worsen over time if left untreated. The nerves that regulate important body motions and functions might be irreversibly damaged by spinal compression. Since nerve damage cannot be reversed and it is critical to seek treatment as soon as symptoms appear. Early detection and therapy can help you improve your condition and, in some situations, reverse spinal cord damage.

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Last reviewed at:
12 Aug 2022  -  5 min read

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