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Myelopathy

Introduction

Myelopathy, also called spinal cord compression, is one of the most common causes of cervical or neck pain in people over age 55 in the United States and possibly the world. Up to 10% of people who have symptoms of spinal stenosis develop myelopathy. The disorder actually comprises several different medical conditions that cause neck pain, including:

  • Transverse syndrome
  • Motor system syndrome
  • Mixed radicular and long tract syndrome
  • Partial Brown-Sequard syndrome
  • Central cord syndrome

The pain associated with myelopathy may be due to problems in the vertebrae and facet joints of your spine, as well as in the muscles, ligaments, and nerves of your spine.

Causes

Normal wear and tear is a common cause of myelopathy. In fact, myelopathy is one of the most common causes of neck pain due to aging. As your body gets older, the normal wear and tear of every-day stress on your spine causes degenerative changes to occur. These changes affect your facet joints, intervertebral discs, and ligaments.

As the discs in your spine grow older they begin to dry out and calcify, which causes them to compress and for the space between your facet joints to close up. This puts added stress on the cartilage that keeps the joints in your spine working properly, and causes the cycle of degeneration to continue. Disc degeneration can also lead to a herniated disc, which can put additional pressure on your spine by pressing against your spinal cord or nerve roots. Degeneration and stress can also cause bone spurs to form. This makes your spinal canal narrow, compressing or squeezing your spinal cord.

Another common cause of myelopathy is injury, such as from car accidents, sports, and falls. These injuries often affect the muscles and ligaments that stabilize your spine, and can also cause bone fractures and joint dislocations. Injuries are a common cause of central cord syndrome.

Myelopathy can also be caused by an inflammatory disease like rheumatoid arthritis, which attacks the joints in your spine and typically affects the area of your upper neck. Less common causes of myelopathy include tumors, infections, and congenital abnormalities of the vertebrae which are present at birth.

Symptoms

The most common symptoms of myelopathy include neck stiffness, deep aching pain in one or both sides of your neck and possibly your arms and shoulders, and possibly stiffness and weakness in your legs and difficulty when walking. You may also feel a grating or crackling sensation when you move your neck. Patients with myelopathy commonly experience stabbing pain in their arm, elbow, wrist, or fingers, a dull ache in the arm, or numbness. Myelopathy can also cause position sense loss, which makes you unable to know where your arms are without looking at them, and incontinence. The symptoms of myelopathy progress slowly over many years and may not become evident until your spinal cord has been compressed by at least 30%.

Diagnosis

The first step in diagnosing myelopathy is a medical history and physic al exam . Your doctor will look specifically for problems with your reflexes, particularly to see whether you have an exaggerated or overactive reflex, which is called hyper-reflexia. Your doctor will also check for muscle weakness particularly in your arms, numbness in your arms and hands, and atrophy, which is a condition in which your muscles deteriorate and shrink in size.

If the results of your history and physic al exam lead your doctor to believe you may have myelopathy, additional diagnostic tests may be ordered including X-rays to check the alignment of the vertebrae in your neck, an MRI to look for spinal cord compression, and a myelogram to check for bone spurs and narrowing of your spinal canal. An electromyogram (EMG) may be helpful in excluding other disorders that may cause symptoms similar to myelopathy.

Treatment

Conservative Treatment

Although surgery to decompress the spinal cord is the best treatment for most patients with myelopathy, watchful waiting is an appropriate approach for patients with mild symptoms. If your myelopathy is mild, your doctor may recommend a brace to immobilize your neck (cervical spine), exercises to improve neck strength and flexibility, manipulation, and pain medication such as a nonsteroidal antiinflammatory drug (NSAID). Some experts recommend against conservative treatment for myelopathy because some conservative treatments have been shown to not be helpful, and in some cases to cause neurological complications.

Epidural steroid injection (ESI)

An epidural spinal injection (ESI) can be used to relieve the pain of a muscle strain or sprain, as well as to decrease inflammation. Injections can also help reduce swelling. Steroid injections are a combination of cortisone (a powerful anti-inflammatory steroid) and a local anesthetic that are given through your back into the epidural space. ESI is not always successful in relieving symptoms of inflammation. They are used only when conservative treatments have failed.

Surgical Treatment

The main goal of surgery for myelopathy is to decompress the spine. Your doctor may choose to perform a laminotomy using a posterior approach (through an incision in your back), which opens up the vertebrae in your spine that may be pressing on your spinal cord to give your spinal cord more room. However, this procedure may not be appropriate for all patients because it can lead to segmental instability and development of kyphosis. Your doctor may also choose an anterior cervical approach (through the front of your neck), which allows your doctor to directly see and remove any bone spurs and disc materials that may be pressing on your spinal cord. During surgery, your doctor may also perform a spinal fusion to reduce the risk of complications after surgery.


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