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Cervical Myelopathy

Cervical myelopathy, also referred to as cervical spondylotic myelopathy (CSM), is an injury to the cervical spine (neck region) caused by cervical spinal stenosis. Cervical spinal stenosis is a narrowing of the spinal canal, which can lead to compression of the spinal cord.

Cervical Myelopathy Hero Image 2

Cervical myelopathy, also referred to as cervical spondylotic myelopathy (CSM), is an injury to the cervical spine (neck region) caused by cervical spinal stenosis . Cervical spinal stenosis is a narrowing of the spinal canal, which can lead to compression of the spinal cord. The spinal canal runs along the inside of the vertebrae and protects the spinal cord. When cervical spinal stenosis causes the spinal cord to become compressed, that compression in the neck region can affect other areas of the body, including the arms and legs. Cervical myelopathy can occur in just one vertebra, or in multiple cervical vertebrae.

 

What causes Cervical Myelopathy?

Cervical myelopathy is caused by a narrowing (called stenosis) of the space surrounding the spinal cord that occurs due to inflammation or compression of the spine.

 

Cervical myelopathy can develop as the result of:

 

  • Normal wear and tear caused by aging
  • Cervical spinal bone spurs
  • Arthritis
  • Spinal infection
  • Injury or trauma to the cervical spine

Cervical myelopathy is most common in these sports:

  • Football
  • Ice hockey
  • Rugby
  • Wrestling

Symptoms

Symptoms of cervical myelopathy affect the neck, upper back, shoulders, arms, hands, and fingers. Early signs of cervical myelopathy typically include:

 

  • Pain
  • Numbness and/or tingling in the arms, hands, and/or fingers
  • Clumsiness and/or loss of fine motor skills
  • Stiffness in the neck and upper back

If cervical myelopathy is not treated early, symptoms can worsen and may even lead to:

  • Loss of urinary and/or bowel control
  • Issues with balance/walking
  • Weakness of the arms and/or legs
  • Paralysis

When to see a doctor

If you have symptoms of cervical myelopathy, make an appointment to see an orthopedic specialist. Waiting to seek help can result in a worsening of symptoms and the need for surgical intervention.

Your doctor will do a physical examination of the neck and body to look for:

  • Any changes in reflexes
  • Strength and balance of the legs or trouble walking
  • Any weakness in the arms

To understand what is causing cervical myelopathy, your doctor will prescribe one or more of the following imaging tests:

  • X-ray
  • MRI
  • CT scan
  • Myelogram

Non-operative treatment

Mild cases of cervical myelopathy are treated using non-operative methods, including:

  • Wearing a collar to minimize movement of the neck and allowing it to heal
  • Physical therapy to stretch and strengthen the neck muscles
  • Nonsteroidal anti-inflammatory drugs (NSAIDs), like ibuprofen and naproxen
  • Epidural steroid injections to reduce inflammation

Surgical Treatment

Surgery can alleviate pressure on the spinal cord when symptoms are severe, or if conservative treatment methods do not relieve symptoms. The type of surgery your doctor recommends will depend on the severity of your diagnosis and the underlying cause of cervical myelopathy.

The surgeon may perform surgery from the front of the neck, which is called an anterior approach. These surgical procedures may include the following:

  • Anterior cervical discectomy and fusion: Damaged vertebral discs are removed to create space in the spinal canal. A bone graft is placed where the disc originally was to stabilize the spine.
  • Anterior cervical corpectomy: Damaged vertebrae and intervertebral discs are removed to create space in the spinal canal.

In other situations, the surgeon may perform surgery from the back of the neck, which is called a posterior approach. These surgical procedures may include the following:

  • Posterior cervical laminectomy: The lamina (the back portion of the vertebral bone) is removed to create space in the spinal canal.
  • Posterior cervical laminectomy and fusion: The lamina is removed to create room for the spinal canal. A bone graft is placed where the lamina originally was to stabilize the spine.
  • Posterior cervical laminoplasty: A portion of the lamina is removed and fixed in an open position to widen the spinal canal.

Recovery

The time it takes to recover from cervical myelopathy depends on the severity of your diagnosis as well as your prescribed treatment or procedure requirement. Some patients may find relief from their symptoms days or even weeks after using conservative treatments, whereas full recovery from surgery could take as long as three to four months. Patients can start to resume low-level activities, such as walking and using a stationary bike a few weeks after surgery, but only with approval from their doctor. Your doctor may recommend that you start a physical therapy program four to six weeks after surgery to regain strength and mobility of the neck and other affected areas of the body like the arms and legs.

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