Cervical Myelopathy

The clinical syndrome that results from a disorder in the spinal cord that disrupts or interrupts the normal transmission of the neural signals is called a "myelopathy". For anatomical reasons, cervical myelopathy may involve the arms and hands, legs, and bowel and bladder function.

Causes:-

Cervical myelopathy is caused by:

• A slipped disk
• Cervical disks degeneration eg spondylosis
• Tumors inside the spinal cord or compressing on the spinal cord
• Bone spurs
• Dislocation or fracture of cervical spine eg trauma
• Autoimmune disease, such as transverse myelitis, multiple sclerosis, or neuromyelitis optica
• Ossification of posterior longitudinal ligament

Cervical myelopathy secondary to degeneration is called "cervical spondylotic myelopathy" to indicate that spondylosis is the root cause of the syndrome.

Symptoms :-

The symptoms of cervical myelopathy depend on the level(s) of the spinal cord that are involved and the pattern of the involvement

Symptoms may include:

• Pain in the shoulder and arms .Neck pain may also be present but is frequently not a significant complaint
• numbness of the hands, clumsiness of the hands, arm weakness, hand weakness
• Tingling or numbness in the upper and lower limb
• leg stiffness ("walking like a robot")
• 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 eg urinary urgency
• Weakness below the waist or in all four limbs

The timing of the appearance of symptoms and their progression is also highly variable from person to person. The rate of progression of an individual's symptoms may change over time, with periods of relatively rapid change interspersed with periods of stability or minimal progression.

Risk Factor:-

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

Diagnosis :-

The clinical diagnosis of cervical spondylotic myelopathy can be difficult because of the multiple potential causes of similar symptoms and the variable presentations. Ultimately the diagnosis is usually made based on the patient's history and examination and radiographic studies that confirm critical cervical stenosis with compression of the spinal cord. Post-myelography computed tomography (myelo-CT) or magnetic resonance imaging (MRI) may be used to obtained high-resolution images of the cervical spinal canal and the spinal cord. The presence of significant compromise of the spinal canal with pressure on the spinal cord in an appropriate location to explain a patient's symptoms is generally sufficient to make the diagnosis of cervical spondylotic myelopathy.

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:

• X-ray
• MRI scan
• CT myelogram

Other tests may include:

• Electromyography (EMG)
• Somatosensory evoked potentials
• Visual evoked potential test (VEP)

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.

Treatment:-

Nonsurgical Approaches

Your doctor may recommend that you do:

• Physical therapy
• Occupational therapy
• Other approaches, such as ultrasound therapy, heat therapy, or electrical stimulation

Medication

Your doctor may prescribe:

• Non-steroidal anti-inflammatory drugs (NSAIDS)
• Corticosteroids
• Neurotropic medication(pregaba and methyl cobalamine)

Surgical treatment

The key to the treatment of cervical spondylotic myelopathy is to remove the pressure from the spinal cord. The surgery is performed to prevent the progression of symptoms; clinical improvement may or may not occur. You will need to discuss your prognosis with your spine surgeon prior to making a decision to have surgery.

Surgical procedures to decompress the spinal cord include approaches from the front of the neck (anterior cervical discectomy and fusion, anterior cervical corpectomy and fusion), from the back of the neck (cervical laminectomy, cervical laminectomy and fusion, cervical laminoplasty) and combined procedures in which both an anterior and a posterior approach are used. The exact procedure performed is based partly on the location of the stenosis and the overall alignment of the cervical spine, but many factors are considered in the decision.