What is Cervical Myelopathy & How is it Treated?
What is Cervical Myelopathy?
To understand Cervical Myelopathy, let us first understand the anatomy of the cervical spine briefly. The cervical spine is a part of the spinal cord with the thoracic and lumbar spine being the other two parts of the spinal cord. The cervical spine has seven vertebrae which are the smallest of the vertebrae compared to vertebrae of all the other spines and is located in uppermost portion of the body. Together, the cervical spine supports the skull, moves the spine, and protects the spinal cord. It has a bunch of nerves which are connected to the brain.
Cervical Myelopathy is a pathological condition in which there is damage done to the cervical spine. This damage to the cervical spine may be caused by a slipped disc, degenerative disorders which occur due to normal process of aging, a tumor compressing the cervical spine, or any accident or trauma to the cervical spine. Sportsmen who stretch and strain their spine regularly and put a lot of pressure on the spine are prone to Cervical Myelopathy.
What are the Causes of Cervical Myelopathy?
Some of the causes of Cervical Myelopathy are:
- Slipped disc
- Degenerative disc disease
- Tumors in the cervical spine compressing the spine
- Bone spurs
- Neck fracture
- Trauma due to an accident or a sporting injury can cause cervical myelopathy
- Autoimmune diseases like transverse myelitis or multiple sclerosis may also cause Cervical Myelopathy.
What are the Risk Factors for Cervical Myelopathy?
Some of the risk factors for Cervical Myelopathy are:
- Frequent infections may predispose an individual to Cervical Myelopathy
- Ischemia which is condition in which there is reduced blood supply may also be a cause of Cervical Myelopathy
- People with autoimmune disorders like rheumatoid arthritis and multiple sclerosis are more prone to develop Cervical Myelopathy in the long run.
- People with a prior history of bone or back problems are also predisposed to Cervical Myelopathy
- Being in an occupation where the spine is put under tremendous pressure like construction and manual labor may cause Cervical Myelopathy.
What are the Symptoms of Cervical Myelopathy?
Some of the symptoms of Cervical Myelopathy are:
- Pain in the shoulder and arms
- Tingling or numbness in the upper and lower extremities
- Ambulation problems
- Balance difficulties
- Muscle weakness
- Problems with neck flexion can be a symptom of cervical myelopathy.
- Problems with fine motor skills like buttoning shirt or tying shoe laces
- Bowel or bladder dysfunction.
How is Cervical Myelopathy Diagnosed?
In order to diagnose Cervical Myelopathy, the treating physician will first take a detailed history of the patient inquiring as to when the symptoms started, was there a history of any accident or injury to the spine, the occupation of the patient to ascertain whether lot of pressure is being put on the spine causing the symptoms of cervical myelopathy.
The next step towards diagnosing Cervical Myelopathy is a detailed physical examination of the neck region to look for areas of tenderness on palpation. The physician will also do a range of motion of the neck which will be reduced and painful. A neurological examination will also be done to look for muscle weakness and checking the fine motor skills of the patient. The next step will be to obtain radiological studies like CT or MRI scan of the cervical spine to look for areas of stenosis or any other abnormalities like a tumor compressing the spine and causing symptoms. The physician may also order other tests like an EMG, SSEP to look for abnormalities. These tests will confirmatively diagnose Cervical Myelopathy.
How is Cervical Myelopathy Treated?
The treatment for Cervical Myelopathy revolves around treating the cause of the condition, working on improving the function that may have been lost due to the symptoms, relieving pain with the help of pain medications, exercises for strengthening the neck muscles. Surgery is the best way to treat Cervical Myelopathy. Surgery is recommended for treatment of Cervical Myelopathy in cases where there is pressure on the cervical spine.
Surgery for Cervical Myelopathy
The different types of surgeries that can be done to treat cervical myelopathy are:
Cervical Discectomy: This is a procedure in which a part of the offending disc that is putting pressure on the spine is removed
Laminectomy: This is a procedure in which a part of the vertebra known as lamina is removed
Cervical Fusion: This is a surgery in which the offending vertebrae are fused together for relief from symptoms of Cervical Myelopathy.
Conservative Treatment for Cervical Myelopathy:
Some of the conservative approaches for treatment of Cervical Myelopathy are:
- Physical therapy
- Occupational therapy
- Application of heat or ice
- Electrical stimulation
Medications to Treat Cervical Myelopath:
Medications can also be given for reduction of symptoms from Cervical Myelopathy. Some medications given are NSAIDs for calming down pain and inflammation like ibuprofen and Tylenol, corticosteroids. A medication for autoimmune disorders like Rituximab can be given if autoimmune disorders are the cause for Cervical Myelopathy.
How Can Cervical Myelopathy be Prevented?
Cervical Myelopathy is preventable condition and if an individual follows certain guidelines then he or she can stay away from Cervical Myelopathy. These guidelines are:
- If you have a job where you have to sit for long periods of time then maintain a correct sitting posture and not put pressure on the neck by leaning forwards for long periods while sitting.
- Take adequate safety measures if you are involved in contact sports which may affect the neck region.
- Keep the neck movement as limited as possible to prevent Cervical Myelopathy.