JOIN USCervical myelopathy is a condition caused due to compression of the spinal canal in the neck region.
It often leads to cord dysfunction and affects patients across all age groups. There are many underlying causes for the condition, however among the common ones are spondylosis (called as spondylotic myelopathy) and rheumatoid arthritis.
Usually, cervical myelopathy shows no initial symptoms and even if it does, they can be so subtle that the diagnosis may easily be missed or misled. Also, many a times, patients start experiencing neck pain only at an advanced stage, which makes treatment more difficult.
Other causes
Apart from spondylosis and rheumatoid arthritis, cervical myelopathy may be caused due to numerous other reasons such as:
A slipped disc
Degenerated cervical discs
Tumors inside the spinal cord
Bone spurs
Fracture of the neck
Injury to the cervical spine
Autoimmune diseases such as multiple sclerosis or neuromyelitis optica
Bone or back problems
Narrow spinal canal
History of cancer that involves bones
Symptoms
They may depend on factors like the cause of the disease. However, the most commonly observed symptoms include difficulty to work with small objects (like buttoning up your shirt), muscle weakness and pain in the shoulder and arms, changes in handwriting, tingling or numbness in the arms, etc.
Advanced cases may show symptoms like difficulty in walking, increased tripping or imbalance, irregular movements, etc. And some extreme cases of spinal cord compression may even report feeling of electric shock-like sensations below the waist or arms and problem flexing the neck, etc.
In the later stages of the disease, some patients usually complain of weakness in their arms or legs, as well as changes in their bowel habits.
Pathology
The physical act of compression or stenosis may be a result of conditions such as degenerative changes of the cervical spine, known as cervical spondylotic myelopathy. Patients who are born with a smaller spinal canal diametre have a higher propensity to compress the spinal cord when degeneration occurs. Another condition that results in compression of the cord is known as ossification of the posterior longitudinal ligament (OPLL). In this condition, the ligament in the spinal canal overgrows with abnormal bone, and this in turn causes compression of the spinal cord.
Diagnosis
Imaging tests required to diagnose cervical myelopathy and to evaluate the spine and surrounding structures may include X-ray, MRI and CT scans with dye. Other tests may include electromyography (EMG), somatosensory evoked potentials and visual evoked potential test (VEP)
Treatment and surgical options
To treat cervical myelopathy, it is important to treat the cause of the myelopathy. Based on that, your pain can be reduced or managed. Strengthening exercises can help in reliving discomfort and pain. But, if there is any kind of structural pressure being exerted on the spinal cord, you may need an immediate surgery. This is necessary to avoid any further injury. There are different kinds of surgery and procedures recommended to stabilise the neck, such as:
Discectomy: This surgery requires removal of a part of an intervertebral disc that is exerting pressure on the spinal cord or nerve root.
Laminectomy: This surgical procedure requires removal of a portion of a vertebra, called the lamina.
Fusion of the vertebrae: Patients with instability or significant neck pain would probably best benefit form a fusion.
Cervical fusion: During this treatment procedure, screws and a plate are used to prevent the vertebrae from exerting pressure on the spinal cord.
Laminoplasty: It’s a newer treatment, in which the spinal canal is enlarged without fusion, with less risk of instability. Laminoplasty is becoming the treatment of choice for many patients with cervical spondylotic myelopathy. However, it is not recommended for everyone.
Once deemed necessary, surgery should not be foregone by the patient, as the condition is likely to worsen into paralysis and incontinency.
Prevention
Though it is difficult to prevent cervical myelopathy, one can follow these guidelines to prevent accidents and strains:
Emphasise on ergonomics like learning correct lifting techniques, improving your posture, and sitting correctly, especially while working on laptop, etc.
Avoid sports if you have had any disc problem in the past.
Limit neck movement.
Rise slowly from a seated or laying position.
(The author is the head of Mumbai Spine Scoliosis & Disc Replacement Centre, Bombay Hospital, Mumbai)