The condition
Cervical myelopathy is a condition of the neck in which the spinal cord is compressed due to changes in the spine that cause narrowing of the spinal canal.
This condition is usually found in patients over 50 years of age. Less common causes are trauma, herniated discs and congenital stenosis.
Because the spinal cord carries signals and information to and from many parts of the body, patients with cervical myelopathy experience a variety of symptoms, such as weakness and numbness in the arms, loss of balance and coordination of movements, and neck pain.
With age, arthropathy, inflammation, osteophytes and flattening of the discs between the vertebrae can cause pressure on the spinal cord and nerve roots. Myelopathy usually progresses slowly as a result of gradual degeneration of the spine (spondylosis). But it can also have a more rapid form.
Causes include:
- Narrowing of the spinal canal from degenerative lesions
- Central herniated discs (herniated intervertebral discs)
- Autoimmune diseases such as rheumatoid arthritis of the spine in which lesions are created
- Cysts, haematomas and tumours of the spine, including bone cancer
Also, acute myelopathy may occur as a result of
- injury,
- infection,
- inflammatory condition,
- radiotherapy
- neurological diseases.
- Pain in the neck, pain in the hands
- Tingling, numbness, weakness
- Disorders in fine movements
- Increased and/or abnormal reflexes
- Gait disorders
- Arthocystic disorders
- Balance disorders
- Movement coordination disorders
The diagnosis of cervical myelopathy is based on the following tests:
- Medical history, clinical and neurological examination
- Simple X-rays
- Magnetic resonance imaging
- Myelography
- Neurophysiological tests such as electromyography or somatosensory evoked potentials.
The treatment
The treatment of the condition depends on its cause
Conservative non-invasive treatment
It includes splints, physiotherapy and medicines. These treatments may be used in mild forms of cervical myelopathy and are aimed at reducing pain and returning to daily activities.
Conservative treatment does not remove the pressure. The symptoms will get progressively worse or even suddenly sometimes. As soon as the patient notices some symptoms of deterioration, it is necessary to contact the attending physician immediately because some of them may be irreversible!
It is very important to stop deterioration in the early stages!
Invasive treatment
Invasive (surgical) decompression of the spine is the most common surgical treatment. Various techniques can be used depending on the position of the pressure, the presence or absence of instability, the age and general condition of the patient:
- Petalectomy
- Horseshoe surgery
- Minimally invasive techniques
- Posterior decompression with posterior spinal fusion
- Anterior decompression (discectomy or body dissection) with anterior spinal fusion
- Combination of the above
