Cervical Spinal Cord Compression and Myelopathy

Cervical Myelopathy is a pattern of symptoms that most often occur when the spinal cord is compressed in either the cervical (neck) or thorasic (chest) regions. The symptomology can be either acute (rapid obvious onset) or progressive (gradual) and can be from cord compression or from problems within the spinal cord itself.

Although the problem comes from a degenerative process in the neck, neck pain is not usually one of the symptoms. Most often the symptoms usually occur in the arms, hands, and legs. Weakness in the hands, difficulty working with them is the most common symptom. The symptoms often mimic those of Carpal Tunnel Syndrome.

Symptoms may also occur in the legs with the first usually being the inability to run. As you get older you do not do this as often so many times it goes unnoticed. However, as the symptoms progress, the legs start to get stiff and jumpy. When you attempt to walk at a quick pace, you may start to stiffen up and trip over your own feet, and this causes you to slow down. The legs gradually weaken, especially the thighs. As symptoms progress, the feet start to go numb and you have to be careful how and where you walk because you can no longer tell where you are putting your feet without looking at them. The numbness may also move up the body to the pelvic area.

There are generally two main reasons this problem occurs, Acute Cervical Disc Rupture, and Chronic Degeneration in the neck with single or multiple levels of compression from osteophytes (spurs). Some of the other causes can be tumors or vascular lesions in or near the spinal cord, infection around the spinal cord, spinal cord trauma, and some neurological conditions.

Diagnosis of myelopathy is most often made from two things, symptomology and test results. The first test will most likely be simple Xrays. Xrays will show a loss of heighth in the disc(s), the possibility of osteophytes, and/or that the spine is not straight. The next test will most likely be an MRI. This test produces images similar to a CT Scan but they are generated using magnetic resonance and computer graphics rather than with radiation. Another test that is sometimes used is the Cervical CT Myelogram. This test involves the injection of contrast into the cerebrospinal fluid around the spinal cord and is followed by a CT Scan. The contrast makes it easier to see exactly what is going on. This test is used sometimes if the MRI does not give a definative diagnosis.

How this is treated depends on several factors; how severe your symptoms are, what kind of symptoms you are having, the test results, and what the physician finds on examination. If your symptoms are not too severe and there is nothing found upon examination to show signs of serious damage, your physician might recommend a more conservative approach. However, if you are showing signs and symptoms of a disabling nature it is possible that your physician will recommend surgery. Should there be no evidence of spinal cord damage then surgery might not be the initial course of action. If the damage appears to be severe however, surgery might be the best option available to you. It is possible that if the test results show the spine to be so badly damaged that surgery would only make things worse in the long run, you may be advised against it. However, if the images show that the spinal cord is severely compressed, your physician may be very concerned that your condition will deteriorate rapidly, so in this case surgery will most likely be recommended to prevent this from occurring.

If you need surgery there are three types of procedures that are used in this situation. Cervical Laminectomy is where a complete removal of one or more lamina takes place. Anterior Cervical Discectomy and Fusion is when the disc rupture and any spurs are removed from the front and the disc replaced with a bone graft. And Cervical Vertebrectomy and Fusion is a similar procedure and involves the total or subtotal removal of one or more vertebrae to accomplish nerve/spinal cord decompression.