Cervical myelopathy is a serious condition of the spine that may lead to permanent disability if left untreated. The cervical vertebrae protect the spinal cord in the neck. This region has nerve fibres that extend to the upper and lower extremities as well as the bladder and bowels. Cervical myelopathy may occur as a chronic degenerative problem or an acute injury.
Anatomy of the Cervical Region
The neck has seven vertebrae that extend from the base of the skull to the bottom of the neck. These vertebrae are separated by disks to cushion and support the spine in movement and held together with muscles and ligaments. Within the spine is a canal that houses the spinal cord. The spinal cord is a rope of nerve fibres that take sensory input from your body and send it up to the brain for processing. It also sends motor input from the brain down into the extremities to control your arms, hands, legs, bladder and bowels.
Cervical myelopathy is an injury to the spine. This may be a simple irritation that inhibits motor and sensory function or necrosis of the nerve. Necrosis is the death of the nerve cells that left untreated can lead to permanent and increasing disability. Not all cases of myelopathy require surgical intervention, but if you are experiencing numbness and weakness with loss of function in your arms or legs, it is important to consult your doctor immediately to determine the best course of treatment.
The most common symptom of cervical myelopathy is neck pain accompanied by radiating pain into one or both of your arms. You may experience numbness and tingling in your fingers and find it difficult to hold objects. Everyday tasks such as writing, opening a jar or a door may become difficult. In extreme cases, leg weakness is also experienced, making walking more problematic and increasing the risk of falls. You may begin to walk differently to compensate for weakness and pain.
Your doctor will ask you a series of questions and do several reflex tests to determine which nerves if any are affected. If you are in extreme pain or symptoms do not resolve on their own, an MRI will be ordered to look at the soft tissue along the spine to determine if a nerve is being pinched. Further tests, such as an electromyography and nerve conduction velocity exams, may be done to see what muscles are affected. These tests use electrical impulses to measure sensory and motor reception.
The prognosis is determined by the cause of the cervical myelopathy. If it is an irritation due to a bulging disk, anti-inflammatory medicine or cortisone shot may alleviate the swelling causing the problem. If your problem is more serious, such as a herniation that will not respond to anti-inflammatory medicine, an anterior decompression and fusion may be needed. This is a surgical procedure that removes the disk and replaces it with a bone graft and fuses the vertebrae in the affected area to relieve pressure. Degenerative conditions, such as cervical stenosis, cause a narrowing of the canal and may require major surgery called a laminaplasty.