Myelopathy

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What Is Myelopathy?

Myelopathy is a condition that involves a problem with the spinal cord. The spinal cord travels through the bones in your spine. Nerve fibers from the spinal cord carry messages from the brain to other parts of your body. With myelopathy, the spinal cord gets compressed or squeezed. Most often, this pressure comes from bone spurs (a growth of new bone off the edge of a bone) or from a disk in your spine that bulges outward. As the spinal cord gets squeezed, the nerves aren’t able to carry the messages properly, causing symptoms such as pain, tingling, or weakness.

Myelopathy can happen to anyone, but it is more common in adults older than age 55. It can affect any part of your spine, such as the neck area or upper or lower back. Most often, it occurs in the neck area.

What Causes Myelopathy?

In most cases, myelopathy is due to changes in the spine that occur as a person gets older. With age, the disks in the spine may thin and wear out. These disks are soft pads of tissue that act as shock absorbers between the bones of the spine (vertebrae). Vertebrae above and below the disk begin to touch and rub together. New bone is created. This may cause bone spurs to form. Some spurs may form in the spinal canal, causing it to narrow (called spinal stenosis) and place pressure on the nerves. A worn disk may also allow the vertebrae to slip forward. This is called spondylolisthesis. Slipping vertebrae can irritate nerves and joints and also worsen stenosis.

Another common cause of myelopathy is a herniated disk. A disk can weaken over time. Sudden movement or injury can then cause the soft center of the disk to push outward. Part of the disk may then press on nearby nerves.

Other causes of myelopathy may include:

• Injury to the spine, such as from a car accident, sports injury, or fall
• Rheumatoid arthritis
• Malignant (cancerous) tumors
• Cysts or benign (noncancerous) tumors
• Hematomas (collection of clotted blood that leaks into the tissue)

What Are the Symptoms of Myelopathy?

Unless the injury to the spinal cord was sudden or severe, symptoms tend to begin slowly and get worse over time. Common symptoms include:

• Pain in the neck, arms, legs, or lower back
• Tingling or numbness (a “pins and needles” feeling) in the arms, fingers, or hands
• Weakness in the arms, shoulders, or hands
• Trouble writing, grasping things, or holding onto things
• Problems walking, as if your legs won’t do what you want them to do

How Is Myelopathy Diagnosed?

The symptoms of myelopathy are similar to those of other conditions. To diagnose your condition, your doctor will take a medical history and perform a physical exam. He or she may order some diagnostic tests to rule out other problems. Diagnostic tests may include the following:

• Imaging tests, such as an X-ray, MRI (magnetic resonance imaging), or CT (computed tomography) scan, may be done to get pictures of the bone, disks, and nerves.
• Contrast imaging studies, such as a myelogram, may also be done. For this test, a contrast dye is used to help soft tissue show up more clearly.
• Electrical tests, such as an electromyelogram (EMG), are another option. This test looks at how nerve fiber signals are being sent out and if there is any damage to the nerves and muscles.

How Is Myelopathy Treated?

If your myelopathy is mild, your doctor may suggest nonsurgical treatment. This often involves the use of a soft collar or brace, medicines (such as pain relievers and corticosteroids), and physical therapy. The goal of this treatment is to lessen your pain and let you get back to your normal activities. It does not correct the compression.

If your compression is moderate to severe, surgery is often the best option. Several different types of decompression surgery may be used including:

• Diskectomy (a part of the disk is removed)
• Corpectomy (the vertebral body and disk spaces are removed)
• Laminectomy (the arched part of the vertebra is removed)
• Laminoplasty (the arched part of the vertebra is thinned out)
• Spinal fusion (vertebrae are fused together, often with a bone graft)

Talk with your health care provider about what type of treatment is right for you.