Cervical myelopathy is a condition in which the spinal cord in the neck has been compressed over long periods of time, leading to the death of spinal cord cells. Untreated, this condition can cause irreversible severe loss of function and eventual paralysis. Getting an accurate diagnosis early on can relieve symptoms and prevent permanent damage from cervical myelopathy.
- Neck pain, soreness, or stiffness
- Sometimes there is little or no pain in the neck itself
- Reduced range of neck motion
- Audible grinding sound with certain neck movements
- Nerve pain, including “electric shock” pains into the arms and legs, especially when bending the head forward
- Symptoms may flare during certain activities or physical movements
- Weakness, numbness, or tingling in the legs, arms, and hands (bad enough to affect grip)
- While walking, legs feel heavy and it is difficult to speed up
- Problems with fine motor function and coordination, including handwriting, typing, buttoning a shirt, holding items without dropping them, etc.
- Problems with balance, dexterity, and reflexes
- Other bodily function issues, such as incontinence
- Symptoms tend to worsen slowly but may go through cycles of remaining stable or rapidly worsening
- Sometimes irreversible loss of function
- Sometimes irreversible paralysis
- Severe compression of the spinal cord over long periods of time
- Spinal cord compression caused by cervical stenosis
- Long-term compression due to arthritis/osteoarthritis, age-related wear and tear, bone spurs, and/or gradual degeneration of bone and cervical discs over time
- The death of spinal cord cells due to prolonged compression of the spinal cord
- Conservative Treatment: Rarely, nonsurgical treatments such as lifestyle modifications, physical therapy, medication, and/or spinal steroid injections may be effective in treating mild cases of cervical myelopathy. However, surgery is often the only effective treatment for cervical myelopathy (especially for moderate to severe cases) and will usually be recommended to prevent irreversible paralysis or loss of function.
- Cervical Stenosis Surgery: This surgery removes the herniated disc and small portions of bone spurs or arthritic bone. It also aligns and decompresses enlarged facet joints. This procedure relieves pressure on the spinal cord to alleviate symptoms of cervical myelopathy.
- Cervical Laminectomy/Posterior Cervical Decompression: This surgery involves removal or restructuring of the lamina and sometimes one or more enlarged facet joints, possibly with fusion of one or more vertebrae. This procedure decompresses the spinal cord to prevent ongoing damage to the spine.
- Cervical Disc Replacement Surgery: This surgery replaces an arthritic, degenerative cervical disc with a fully mobile artificial disc. If a degenerative disc is causing prolonged compression of the spinal cord, this procedure can improve symptoms and will allow the neck to continue moving in a natural, physiological way.
- Anterior Cervical Discectomy and Fusion (ACDF): This surgery is performed through a small incision in the front of the neck. The damaged cervical disc is removed, and a bone graft and/or implant is inserted to stabilize and fuse the vertebrae together. This can alleviate symptoms but restricts some movement due to the vertebral fusion.
- Muscle Sparing and Minimally Invasive Fusion: This surgery uses a tubular retractor to allow direct access to the spine with significantly less damage to the soft tissue and muscles. The arthritic disc, bone, and/or bone spurs are removed, and a bone graft and implant are inserted to fuse the vertebrae together and relieve pressure on the spinal cord. This can alleviate symptoms but restricts some movement due to the vertebral fusion.
- Anterior Cervical Corpectomy and Fusion: This surgery, also performed through the front of the neck, removes a majority of the vertebral body where there is multi-level compression, bone spurs, or disc herniations. It is only performed for individuals with severe spinal cord compression. This can alleviate symptoms but restricts some movement due to the vertebral fusion.
Frequently Asked Questions
Cervical myelopathy is the result of long-term compression of the spinal cord. If cervical spinal stenosis has caused the bones and/or discs of the neck to compress the spinal cord, it can significantly narrow the spinal column and compress the spinal cord. Prolonged compression can eventually kill spinal cord cells, which can lead to permanent severe loss of function or paralysis.
The symptoms of cervical myelopathy are often misdiagnosed as other conditions, such as carpal tunnel syndrome or peripheral neuropathy. A combination of a detailed medical history, physical examination, MRI, CT scan, X-rays, reflex testing, and other evaluation methods can yield a proper diagnosis.
Surgery is usually the only effective treatment for cervical myelopathy, especially for moderate to severe cases. Decompression of the spinal cord is essential to prevent lasting damage. Dr. Pehler will carefully consider your situation before recommending the appropriate spinal decompression surgery to treat cervical myelopathy.
The details of your recovery will vary depending on the surgical technique chosen. In most cases, patients can return home on the day of the surgery or within 1 to 2 days. A neck collar may be placed to support the spine as it heals; this may need to be worn for up to several weeks depending on the procedure. Typically, some pain and stiffness are common during recovery but will subside as the tissues heal. More details will be provided for you based on your surgical plan.
All surgeries carry some risks. These include but are not limited to reactions to anesthesia, nerve injury, reduced movement, discomfort, failure to alleviate symptoms, temporary voice hoarseness/change, temporary discomfort when swallowing, and others. The risks of nerve injury are incredibly low due to modern techniques and careful monitoring of the patient during the procedure. All potential risks and benefits will be discussed with you in detail when you are evaluated in clinic.
Cervical myelopathy can have a major impact on quality of life. With cervical myelopathy, compression of the neck has worsened to the point where spinal cord cells have already begun to die. While individuals with cervical myelopathy may go through periods of relative stability, at any point it could rapidly worsen. Without intervention, cervical myelopathy can lead to eventual paralysis and/or irreversible loss of bodily function. If you have any of the symptoms listed above, it is important to see your doctor for an evaluation right away to get an accurate diagnosis and begin your treatment plan.