How to manage myelomalacia and paralysis?

Question

Hi doctor,

I am a 37.5-year army veteran with a service-related history of cervical spine degeneration. Recent MRI (magnetic resonance imaging) findings confirm myelomalacia at the C5–C6 level with severe foraminal stenosis. This response was demonstrated by my chiropractor during the examination.

My primary concern is the potential for progressive spinal cord damage, which could lead to paralysis or even stroke if not managed appropriately.

Veterans affairs is currently encouraging me to resume full-time work or education, which conflicts with my Functional Capacity Evaluation (FCE) that supports only part-time activity due to my functional limitations.

Pain specialists have previously attributed my symptoms to normal aging; however, my condition has been progressively worsening, and I believe this is being overlooked.

Symptom history:

I have undergone two separate courses of physiotherapy within the past year. While this has alleviated some of the radiating pain, it has not improved my persistent balance disturbances or the chronic neck pain. I began experiencing balance issues and dizziness approximately three years ago.

Comprehensive cardiac evaluations, including heart monitoring, revealed no abnormalities. I also had a brain MRI and was assessed by two ENT specialists, but no definitive cause for the dizziness was identified. A previous transient ischemic attack (TIA) led to the suspicion that an old infarct may have affected the cerebellum and contributed to these symptoms. However, around the same time, my neck pain significantly worsened, though no connection between the cervical pathology and my balance problems was made at that point.

Imaging and diagnosis:

A cervical MRI performed in 2012, several years after a prior neck injury, did not show myelomalacia. However, a follow-up MRI conducted last year revealed new onset myelomalacia at the C5–C6 level, likely secondary to spinal cord impingement. This finding raises concern that the underlying damage is progressing, and I am anxious to preserve my remaining functional abilities.

Current symptoms:

Constant, cramp-like neck pain that worsens with prolonged sitting or standing
Limited range of motion, particularly with neck extension (looking upward)
Intermittent, intense radiating pain in the left arm, shoulder, and anterior chest wall
Persistent balance issues and dizziness, not responsive to current conservative measures

Current treatment:

Ibuprofen as needed for general pain management.
Pregabalin, prescribed for radiating leg pain, which I avoid unless necessary, due to its sedative effects.

Please help.

Thank you.

Answer 1

Hi,

Welcome to icliniq.com.

I have gone through your query and understand your concern.

The response to your concern is quite straightforward. Your condition is progressing both clinically and radiologically. The presence of noticeable balance issues is particularly concerning and does not align well with maintaining an active lifestyle.

If you were a younger individual, I might have advised waiting. However, maintaining function and mobility becomes increasingly important as we age. Therefore, I would recommend proceeding with surgical intervention.

Nowadays, surgery for degenerative cervical myelopathy is generally safe and often yields rewarding outcomes. While it is possible to delay surgery, it is important to understand that the condition is unlikely to improve on its own. Earlier surgical intervention tends to offer better long-term results.

I hope I have answered your question.

Let me know if I can assist you further.

Thank you.

Answer 2

Hi,

Welcome back to icliniq.com.

There are a few important points I would like to reiterate:

Discontinue chiropractic treatment – It may worsen your condition. Although chiropractors may claim to improve your symptoms, there is no scientific evidence supporting the effectiveness of chiropractic manipulation in cervical myelopathy, and it can potentially be harmful.
Read about Lhermitte's sign – This is a typical symptom of cervical myelopathy and may help explain the dizziness you are experiencing when pressure is applied to the cervical spine.
Work-related concerns – Your condition is unlikely to worsen simply because of attending college or engaging in intellectual work. You should, however, avoid any heavy lifting or strenuous physical activity. Academic activity alone will not exacerbate the condition.
Natural progression of cervical myelopathy – This condition tends to worsen over time, even without physical exertion or stress. It typically follows a step-ladder pattern, where periods of decline are followed by temporary stability, and then another decline. Unfortunately, the exact timeline for progression is unpredictable.
Recommended activity – Regular walking and proprioception exercises can help improve your overall function and quality of life. These exercises can be learned from reliable online resources. There is no strict need to visit a physiotherapist or chiropractor for these specific activities.

I hope I have answered your question.

Let me know if I can assist you further.

Thank you.