Cervical Myelopathy

(Myelopathy, Cervical)
  • Definition

    Cervical myelopathy is damage to the part of the spinal cord that is in the neck. The cervical spine begins at the base of the skull. It extends to the first seven vertebrae.
    Cervical Spine
    Cervical Spine
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  • Causes

    Cervical myelopathy is caused by:
    • A slipped disk
    • Cervical disks that are worn, known as degeneration
    • Tumors inside the spinal cord or compressing on the spinal cord
    • Bone spurs
    • Dislocation or fracture of the neck
    • Traumatic injury to the cervical spine
    • Autoimmune disease, such as transverse myelitis, multiple sclerosis, or neuromyelitis optica
  • Risk Factors

    Risk factors that increase your chance of developing cervical myelopathy include:
    • Infections
    • Ischemia—restriction of blood supply
    • Autoimmune disorders, such as rheumatoid arthritis, multiple sclerosis, neuromyelitis optica; or other conditions, such as vascular disease or degenerative disease
    • History of bone or back problems
    • Being born with a narrow spinal canal
    • Job or sport involving regular stretching and straining of spine
    • History of cancer involving the bones
  • Symptoms

    Symptoms may include:
    • Pain in the shoulder and arms
    • Tingling or numbness in the arms and legs
    • Trouble walking or balancing
    • Muscle weakness
    • Problems flexing the neck
    • Lightheadedness
    • Problems with fine motor control, such as buttoning a shirt
    • Irregular movements
    • Bowel or bladder problems
    • Weakness below the waist or in all four limbs
  • Diagnosis

    Your doctor will ask about your symptoms and medical history. A physical exam will be done. It will focus on any muscle weakness. A neurological exam may also be done to check your:
    • Reflexes
    • Vision
    • Mental state
    Your doctor may need images of structures inside your body. This can be done with:
    Other tests may include:
  • Treatment

    Talk with your doctor about the best treatment plan for you. This may involve:
    • Treating the cause of the myelopathy
    • Improving functions that you have lost
    • Reducing or managing pain
    • Doing strengthening exercises
    • Teaching you ways to reduce injuries
    • Helping you learn ways to cope with the condition
    Surgery
    If there is structural pressure on the spinal cord, you may need surgery right away. This is to attempt to avoid lasting injury. There are many different kinds of surgery and procedures to stabilize the neck, such as:
    • Diskectomy—a surgical procedure to remove part of an intervertebral disc that is putting pressure on the spinal cord or nerve root
    • Laminectomy—a surgical procedure to remove a portion of a vertebra, called the lamina
    • Fusion of the vertebrae
    Cervical Fusion
    Sagittal View of a Cervical Fusion
    Screws and a plate prevent the vertebrae from putting pressure on the spinal cord.
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    Nonsurgical Approaches
    Your doctor may recommend that you do:
    • Physical therapy
    • Occupational therapy
    • Other approaches, such as ultrasound therapy, heat therapy, or electrical stimulation
    • Plasmapheresis
    Medication
    Your doctor may prescribe:
    • Non-steroidal anti-inflammatory drugs (NSAIDS)
    • Corticosteroids
    • Rituximab—This is an antibody used to treat some autoimmune disorders.
    Other medications that affect the immune system are also sometimes used.
  • Prevention

    It is difficult to prevent this condition. Follow these guidelines to prevent accidents and strains:
    • Ask about ergonomics in your workplace. Some examples of ergonomics include learning correct lifting techniques, improving your posture, and sitting correctly.
    • Avoid contact sports if you have had disk disease with compression of the spinal cord.
    • Limit neck movement.
    • Take these measures to prevent falls:
      • Remove throw rugs and other obstacles from the floor.
      • Install a night-light near stairs and your bed.
      • Install handrails in the tub and shower.
      • Rise slowly from a sitting or lying position.
  • RESOURCES

    National Institute of Neurological Disorders and Stroke http://www.ninds.nih.gov

    National Spinal Cord Injury Association http://www.spinalcord.org

    CANADIAN RESOURCES

    Canadian Spinal Research Organization http://www.csro.com

    Health Canada http://www.hc-sc.gc.ca

    References

    Cervical myelopathy. Johns Hopkins Medicine website. Available at: http://www.hopkinsmedicine.org/neurology%5Fneurosurgery/specialty%5Fareas/spine/conditions/cervical%5Fmyelopathy.html. Accessed November 16, 2013.

    Check for safety: a home fall prevention checklist for older adults. Centers for Disease Control and Prevention website. Available at: http://www.cdc.gov/ncipc/pub-res/toolkit/Falls%5FToolKit/DesktopPDF/English/booklet%5FEng%5Fdesktop.pdf. Published 2005. Accessed November 16, 2013.

    Matsushima T, Yaoita H, et al. Operated family cases of cervical canal stenosis. International Congress Series. 2004;1259:465-469.

    Pollard H, Hansen L, et al. Cervical stenosis in a professional rugby league football player: a case report. Chiropractic & Osteopathy. 2005;13:15.

    Spondylolysis. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated November 13, 2013. Accessed November 16, 2013.

    Young WB. Clinical diagnosis of myelopathy. Sem Ultrasound, CT, MRI. 1994;15:250-254.

    Young WF. Cervical spondylotic myelopathy: a common cause of spinal cord dysfunction in older persons. Am Fam Physician. 2000 Sep 1;62(5):1064-1070. Available at: http://www.aafp.org/afp/20000901/1064.html. Accessed November 27, 2012.

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