Myelopathy

What is Myelopathy?

The clinical term “Myelopathy” refers to an injury of the spinal cord as a result of severe compression resulting from trauma, disc herniation, degenerative disease, congenital stenosis, etc. Usually, the spinal cord comprises a group of nerves that runs almost the entire length of our spine. Myelopathy occurs when any part of the spinal cord becomes constricted or compressed. Researches often mix up myelopathy with myopathy. Myopathy refers to a muscular disorder, while myelopathy means the damage of nerves inside our spinal cord ¹.

Symptoms of myelopathy vary according to their location of origin, whatever the conditions cervical, thoracic, or lumbar myelopathy. Cervical myelopathy occurs in the neck area and the associated symptoms include pain in the neck and surrounding areas. Thoracic myelopathy occurs in the middle of the spine due to the compression due to the herniated discs, spinal trauma, or bone spurs. Symptoms associated with thoracic myelopathy include thoracic or abdominal pain and numbness in this affected area. Lumbar myelopathy represents a rare spinal disorder because, in most people, the spinal cord ends in the above of the lumbar spine ².

The symptoms of myelopathy depend on the severity and the location of the pressure. Depending upon the cause, symptoms can develop quickly or slowly. Typical symptoms include loss of sensation, loss of function, and pain or discomfort in the area at the compression point. Other common symptoms of myelopathy include ¹:

• Pain in the neck, shoulder, arm, lower back, and leg
• Numbness, weakness, or tingling
• Walking difficulties
• Loss of bladder control
• Balance problem and incoordination

Myelopathy occurs due to the gradual degeneration of the spine, known as spondylosis. But this condition can also develop as a result of spinal deformity during birth. Myelopathy induced by several conditions such as injury, inflammation, hernia, cysts, spinal tumors, rheumatoid arthritic condition, bone spurs, trauma, flattening of the spinal cord between the vertebrae, etc. Other risk factors of myelopathy include age, overweight, pregnancy, diabetes, etc.

How do Neurosurgeons Diagnose Myelopathy?

The prevalence and incidence rate of myelopathy estimates almost 605 and 41 per million in North America ³. Peoples of all ages can experience myelopathy, but older look more prone to develop it due to the arthritic condition. Cervical myelopathy comprises about 55% of the total myelopathy ⁴.

The initial diagnosis of myelopathy includes a brief clinical presentation and pain patterns of patients. Doctors may further recommend the following tests to narrow down the myelopathy diagnosis ⁵:

• X-ray: This helps to show the narrowing and changing the alignment of the spinal cord.
• Magnetic resonance imaging (MRI) scan: This test helps for a detailed look of the spine and spinal canal and shows the area of stenosis.
• Myelography: This uses contrast media and a real-time form of an X-ray to know the abnormalities of the spinal cord.
• Other electrical tests: These include electromyogram or somatosensory evoked potentials to know the functional status of nerve. These tests help to know the sensation and movement ability of your limbs.

How do Neurosurgical Specialists Treat Myelopathy?

Treatment of myelopathy depends on the cause and symptoms of the patients. Most patients with myelopathy respond well to non-surgical, conservative treatment. Non-surgical myelopathy treatment includes ³:

• Pain management: Medications like nonsteroidal anti-inflammatory drugs, muscle relaxants, or pain relievers can help to relieve pain.
• Exercises: The practice of doing exercises such as yoga, swimming, or walking can be helpful. You need to avoid excess weight-bearing and practice gentle exercises daily.
• Physical therapy: This includes strengthening the muscles and de-stressing the spinal structures in your neck and back. Maximum physiotherapists suggest doing transcutaneous electrical nerve stimulation stretching exercises, soft tissue massage, or acupuncture to improve your condition.

Surgical treatment of myelopathy includes spinal decompression surgery to relieve pressure on the spinal cord. This also helps to remove bone spurs or herniated discs around your spinal cord. You need to contact your doctor for the best available option for your treatment.

References

1. Badhiwala, J. H. et al. Degenerative cervical myelopathy — update and future directions. Nat. Rev. Neurol. 16, 108–124 (2020).
2. Mowforth, O. D., Davies, B. M., Goh, S., O’Neill, C. P. & Kotter, M. R. N. Research Inefficiency in Degenerative Cervical Myelopathy: Findings of a Systematic Review on Research Activity Over the Past 20 Years. Glob. Spine J. 10, 476–485 (2020).
3. Hilton, B., Tempest-Mitchell, J., Davies, B. & Kotter, M. Route to diagnosis of degenerative cervical myelopathy in a UK healthcare system: A retrospective cohort study. BMJ Open 9, 1–9 (2019).
4. Gibson, J. et al. Degenerative cervical myelopathy: A clinical review. Yale J. Biol. Med. 91, 43–48 (2018).
5. Goel, A. Degenerative cervical myelopathy. Neurospine 16, 793–795 (2019).