Cervical Myelopathy Causes, Symptoms & Treatment Options

Overview

Cervical myelopathy, also referred to as cervical spondylotic myelopathy (CSM), is a cervical spine condition affecting the neck region, caused by cervical spinal stenosis. Cervical spinal stenosis is the narrowing of the spinal canal, which can result in compression of the spinal cord. The spinal canal runs through the vertebrae and protects the spinal cord. 

When this narrowing compresses the spinal cord in the cervical region, it can impact other parts of the body, including the arms and legs. Cervical myelopathy may affect a single vertebra or involve 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.

• How the Injury Occurs: The condition develops when ongoing compression or sudden trauma reduces space in the cervical spinal canal and injures the spinal cord.
• Common Everyday Causes: Poor posture, prolonged screen use, heavy lifting, repetitive neck strain, and untreated neck injuries can gradually lead to cervical spinal stenosis.

Cervical myelopathy can develop as a result of:

• Normal wear and tear caused by aging: Gradual degeneration of discs and joints reduces spinal canal space, leading to spinal cord compression.
• Cervical spinal bone spurs: Abnormal bone growth narrows the spinal canal and presses against the spinal cord.
• Arthritis: Chronic joint inflammation thickens spinal tissues, limiting space around the spinal cord.
• Injury or trauma to the cervical spine: Sudden impact or force damages vertebrae or discs, resulting in spinal cord pressure.

Cervical myelopathy is most common in these sports:

• Football: Repeated tackles and high-impact collisions strain and compress the cervical spine.
• Ice hockey: Falls and body checks cause forceful neck movements and spinal compression.
• Rugby: Scrums and tackles apply intense axial load to the cervical spine.
• Wrestling: Neck flexion, twisting, and sustained holds increase spinal cord stress.

Symptoms

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

• Pain: Persistent neck or upper back discomfort that may radiate into the shoulders or arms.
• Numbness and/or tingling in the arms, hands, and/or fingers: Abnormal sensations caused by spinal cord compression affecting nerve signals.
• Clumsiness and/or loss of fine motor skills: Difficulty with precise hand movements, such as buttoning clothes or writing.
• Stiffness in the neck and upper back: Reduced neck mobility due to muscle tightness and spinal changes.

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

• Loss of urinary and/or bowel control: Disrupted nerve signals affecting bladder and bowel function.
• Issues with balance/walking: Unsteadiness or coordination problems caused by impaired spinal cord function.
• Weakness of the arms and/or legs: Reduced strength and endurance in the limbs due to nerve involvement.
• Paralysis: Severe spinal cord compression resulting in partial or complete loss of movement.

Non-operative treatment

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

• 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(ACDF): 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.Small metal plates or spacers are often used to hold the bone open and keep the spine stable.