What Is Myelopathy?
The spinal cord is a group of nerves housed inside the spine. Myelopathy is an injury to the spinal cord caused by severe compression. A variety of reasons can lead to compression: trauma, congenital spinal stenosis, degenerative disc disease, or a herniated disc. Myelopathy can lead to a wide range of physical symptoms, from fine motor skill issues to loss of bladder control, all due to the increasing pressure and damage on the spinal cord.
What Is The Most Common Cause of Spinal Cord Injury?
As we age, wear and tear, flattening of the spinal discs between the vertebrae, the development of bone spurs, and disc damage all can result in pressure on the spinal cord and the nerve roots exiting the spine. Myelopathy is usually a slow process as vertebrae, bone spurs, or bulging discs begin to press on the spinal cord.
Common causes are:
- Spinal stenosis — This is a narrowing of the bony passageway in the spine through which the spinal cord runs. As issues such as bone spurs begin to decrease the space, pressure builds.
- Disc herniation — As we age our spinal discs become less and less pliable as the discs become drier. Pressure can cause the outer membrane to rupture and the inner gel pushes out or herniates. This protruding gel then often pushes on the spinal cord.
- Trauma or injury — An injury to the spine can lead to damaged vertebrae or to the development of bone spurs leading to acute myelopathy. This can also be the result of spinal infection, inflammatory diseases, radiation therapy, and certain other causes.
Certain factors can increase your risk of myelopathy:
- Improper lifting
- Alcohol abuse
Signs and Symptoms of Spinal Cord Injury
The symptoms of myelopathy vary depending on the location and severity of the spinal cord problem. Some of the conditions and symptoms associated with this problem include but are not limited to:
- Tingling, numbness, or weakness, usually in extremities such as the hands
- Neck, arm, leg, or lower back pain
- Difficulty with fine motor skills, such a holding a pen for writing
- Increased reflexes or abnormal reflexes in the extremities
- Difficulty with walking and balance
- Loss or urinary and bowel control
Spinal cord compression can lead to a loss of sensation, loss of function, and pain or discomfort in the direct area of the compression or in areas served by the nerves involved. Symptoms will increase and intensify over time. It is important to seek medical attention as soon as possible to avoid irreparable spinal cord damage.
Different Types of Myelopathy
Myelopathy can occur in any part of the spine. It is named for the section involved.
Cervical myelopathy – This is the most common form of myelopathy, occurring in the cervical spine, vertebrae C1-C7. Neck pain and shoulder pain are symptoms of cervical myelopathy.
Thoracic myelopathy – This middle section of the spine is the longest, comprised of vertebrae T1-T12, and is less prone to myelopathy. Compression in this section of the spine is usually due to bulging or herniated discs, bone spurs, or spinal trauma.
Lumbar myelopathy – Spinal cord damage is rare in the lumbar spine, vertebrae L1-L5. This is because the spinal cord ends in the top section of the lumbar spine.
How Is Myelopathy Diagnosed?
Symptoms caused by myelopathy are not unique, so diagnosis requires ruling out other possibilities. The team at DFW Center for Spinal Disorders will use these tests in your diagnosis:
- X-rays can rule out other problems such as fractured vertebrae.
- MRI or CT scans provide detailed images of the spine and the spinal canal, showing areas of stenosis.
- Myelography involves the introduction of contrast liquid and a real-time form of x-ray called fluoroscopy to reveal abnormalities of the spinal cord.
- Electrical tests, such as electromyograms or somatosensory evoked potentials, give us an idea of how well your nerves are functioning. These tests measure how nerve stimulation in a hand, arm, leg, or foot is connecting though the spinal cord to the brain.
Treatment of myelopathy ranges from simple observation for young patients with stable myelopathy advancing to immediate surgery to prevent progressive weakness that could evolve to paralysis from significant narrowing around the spinal cord. Surgeries for cervical spondylotic myelopathy range from anterior (front of the spine) surgeries to posterior (back of the spine) surgeries or possibly both.
Non-Surgical Myelopathy Treatment
Non surgical treatments allow for decreased pain reducing the inflammation associated with the spinal cord and nerve root. Both prescription and over-the-counter medications are common non surgical treatments to help relieve and manage myelopathy related pain. Although this has been found to alleviate pain, there are many other conservative options that are geared towards the long-term health of the spine. These non-surgical treatment options include the following:
- Physical therapy is able to target and strengthen the muscles surrounding the spine
- Lifestyle changes to reduce heavy lifting and avoid painful motions and postures
- Quit unhealthy activities such as smoking and poor nutrition
- Soft collards target patients with myelopathy in the cervical (upper) portion of the spine
- Therapeutic massage to relax muscles and connective tissue
Surgical Myelopathy Treatment
The goal of surgery with the DFW team is to relieve pressure on the spinal cord and corresponding nerve roots. This is achieved with decompression surgery. Surgery can also remove bones spurs or herniated disc portions that are pressing on the spinal cord.
Laminoplasty is a common surgery for stenosis. In this surgery, the lamina on the back of the vertebra in question is cut all the way through. This allows the vertebra to open like a door, creating more space in the spinal canal and relieving the source of compression.
If patients may not be able to handle the possible loss of stability that can come with laminoplasty, they may better be served by removing the herniated or bulging spinal disc, placing an artificial spacer in its place, and then fusing the two vertebrae together. This will eliminate motion in the affected segment of the spine.