Cervical Myelopathy

What is cervical myelopathy?

Your skull is connected to your upper back by a series of 7 small bones, known as vertebrae. This is known as your cervical spine. Cervical myelopathy occurs when your spinal cord is compressed. 

There are different types of cervical myelopathy. One common type of cervical myelopathy is known as cervical spondylotic myelopathy (CSM). CSM is age-related, meaning it is caused by gradual degeneration of your spine as you age. However besides age, cervical myelopathy can be caused by other factors as well. 

Cervical myelopathy vs Cervical radiculopathy vs Cervical stenosis

Cervical myelopathy should not be confused with cervical stenosis or cervical radiculopathy. 

Cervical myelopathy occurs when the spinal cord itself is compressed 

Cervical stenosis occurs when space within your spine narrows and as a result, puts pressure on the nerves that run through your spine

Cervical radiculopathy occurs when the nerve roots are compressed or damaged

How will having cervical myelopathy affect me?

There are ways in which having cervical myelopathy may affect you in your daily life. You may experience difficulty moving around and stiffness in your neck, arms and fingers. As a result, this may bring discomfort and inconvenience to your life, especially if there is a job or event that requires you to move around often. Simple daily tasks such as buttoning your shirt or tying your shoelaces may become difficult as well. As the condition progresses, you may also begin experiencing pain which radiates down your arms and lower body, which may interfere with your quality of life.

What does having cervical myelopathy feel like?

Early diagnosis and treatment of cervical myelopathy is key to a good recovery. However, symptoms of cervical myelopathy often progress slowly and due to the initial lack of pain, cervical myelopathy often goes unrecognised by many during its early stages. 

Someone with cervical myelopathy may experience these symptoms: 

Weakness, numbness and tingling. You may experience muscle weakness or a tingling pins-and-needles sensation in your arms and fingers. For example, you may notice yourself not being able to write or grip things properly. In certain cases, you may also even feel a numbness in your fingers. 

Lack of balance and coordination. You may find yourself having a lack of coordination or being more clumsy than usual. For example you may find yourself having difficulties with walking straight or notice yourself tripping over more often than usual. 

Pain and discomfort. As the condition progresses, you may begin to experience a burning or shock-like pain in your neck and upper back that shoots down your arms, lower back or legs. 

Bladder and bowel dysfunction. In rare cases, you may not be able to control your bladder or bowel movements as a result of cervical myelopathy. You may also find yourself frequenting to the toilet more than usual.

What are the causes of cervical myelopathy?

Medical conditions. Cervical myelopathy can be a result of underlying medical conditions, such as: 

A herniated disc 

  • Your spine is made up of 24 small bones, known as vertebrae, stacked on top of each other. In between each vertebrae, there is a rubbery pad known as a disc that acts as a cushion and prevents the vertebrae from rubbing against each other. Each disc has a harder exterior, known as the annulus, which surrounds an inner core, known as the nucleus. The nucleus contains loose fibers that are suspended in a gel-like substance. 
  • A herniated disc occurs when a fragment of the nucleus pushes out through the annulus as it is weak or torn
  • When a herniated disk happens in your upper back, it could compress on the cervical spinal cord, resulting in cervical myelopathy.

Spinal infections 

  • Spinal infections are rare, but often very serious diseases that happen when pathogens such as bacteria, viruses, parasites, fungi or prion invade the spinal tissues through the bloodstream or peripheral nerves
  • Spinal infections may result in the buildup of pus in your cervical spine, known as an abscess. The abscess can place pressure on your spinal cord, resulting in cervical myelopathy. 

Spinal stenosis 

  • Spinal stenosis occurs when spaces within your spine, known as the foramen, begin to narrow
  • If the space within the cervical spinal canal is reduced too much, this may place pressure on your spinal cord, resulting in cervical myelopathy. 

Spinal injuries. Trauma to the cervical spinal cord may result in cervical myelopathy. An example of this would be whiplash injury, a neck injury resulting from a forceful, rapid back-and-forth movement of the neck.

Tumours. Abnormal growths such as tumours within or near the cervical spine may also compress on cervical spinal cord.

What are the risk factors of developing cervical myelopathy?

Some risk factors of cervical radiculopathy include: 

Age. Research has shown how the frequency of cervical myelopathy increases with age, from 0.6 percent in patients below the age of 20 and reaching 9.1 percent in patients above the age of 70 [1]. This is because as you age, parts of your body naturally begin to degenerate, including your spine. As a result, this would increase your risk of conditions such as a herniated disc and stenosis, all of which would put you more at risk of developing  cervical radiculopathy. 

Family history

Heavy manual labor

Smoking

How do I prevent myself from developing cervical myelopathy?

There is no certain way to completely prevent cervical myelopathy. However, some ways to reduce your risk of developing cervical myelopathy include:

Exercising regularly. Exercising helps to strengthen your back muscles and keep your spine flexible. Some sports that are good for the spine include swimming and yoga.

Maintaining a good posture. Bad postures can create gradual changes to the natural curves of your spine. Thus, keeping your back straight while sitting down and sleeping on a firm mattress that adequately supports your spine may help to reduce your risk of developing cervical myelopathy. 

How is cervical myelopathy diagnosed?

Medical examination. When visiting a doctor, your doctor will most likely conduct a thorough medical examination and several tests before definitively diagnosing you with cervical myelopathy. Your doctor may ask you about your medical history, family history and test your strength and reflexes. 

Imaging. Your doctor may also make use of spinal imaging such as X-Ray, MRI and CT scans to have a detailed look at the cervical spine.

How is cervical myelopathy treated?

Surgery. Surgery is the most common way to treat cervical myelopathy. The type of surgery used is dependent on the cause of your cervical myelopathy. After surgery, most people will take around 3 to 4 months to heal and recover. 

Physiotherapy. For this, your doctor will likely refer you to a physiotherapist. Although not a cure, physiotherapy is important in helping you to remain active and build strength in your neck and back. 

If you think that you may have cervical myelopathy, visit a doctor and seek medical attention immediately.

References
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  1. Al-Ryalat, N. T., AlRyalat, S. A. S., Mahafza, W. S., Samara, O. A., Ryalat, A. T., & Al-Hadidy, A. M. (2017). Myelopathy associated with age-related cervical disc herniation: a retrospective review of magnetic resonance images. Annals of Saudi Medicine, 37(2), 130–137. https://doi.org/10.5144/0256-4947.2017.130 
  2. Cervical Myelopathy. (n.d.). Www.Hopkinsmedicine.org; John Hopkins. Retrieved December 16, 2020, from https://www.hopkinsmedicine.org/health/conditions-and-diseases/cervical-myelopathy