Cervical myelopathy is when someone has dysfunction within the spinal cord as it runs through the neck. It is most commonly caused by pressure on the spinal cord. As we age, we can develop bones spurs, arthritis and disc bulges. All of these can intrude into the space of the spinal cord. The spinal cord is quite sensitive to pressure, such that if it becomes squeezed it may begin to have difficulties functioning and can become damaged.
The spine is made up of 24 bones, called vertebrae, which are stacked on top of one another. These bones connect to protect the spinal cord. The seen small vertebrae that begin at the base of the skull and form the neck make up the cervical spine.
Your spinal cord and nerves travel through the spinal canal carrying messages between your brain and muscles. The intervertebral discs between your vertebrae are flexible, flat and round discs and are about a half-inch thick. They act as shock absorbers when you walk or run.
Cervical spondylotic myelopathy results from worsening changes that occur in the spine as we age. These changes in the discs are often called arthritis or spondylosis. These changes are typical and occur in everyone. Nearly half of all people middle-aged and older have worn discs that do not cause painful symptoms.
Cervical spondylotic myelopathy can arise from bone spurs, a herniated disc, arthritis or an injury to the neck.
People can experience many different symptoms if they have cervical myelopathy. Common experiences include hand numbness, arm pain, weakness in the hands, loss of coordination in the legs or the hands, and difficulty walking. Someone may experience just one and someone else may have all these symptoms. Neck pain may or may not be a part of myelopathy. Many patients are surprised to learn that their symptoms are from a neck issue if their neck does not hurt.
To determine whether you have cervical spondylotic myelopathy, your physician will ask you for a complete medical history and conduct a physical examination. An X-ray, MRI, CT scan or myelogram can confirm the diagnosis.
- Surgery: Many people have some narrowing in the neck that is not causing problems, others have very mild myelopathy that may be safe to watch. However, if cervical myelopathy is caused by compression in the neck, the typical recommendation is to have the pressure alleviated with a surgery. Unlike other spine conditions that tend to get better over time, cervical myelopathy has a tendency to worsen. This may happen quickly over the course of a few months or slowly over years. The concern is that if the spinal cord is damaged, it may not recover. Therefore, it is better to prevent damage than to wait for damage to occur and then hope for a recovery.
- Medications: Nerve medications, like Gabapentin and Lyrica, may ease some of the symptoms of spinal cord compression or damage. They can have the side effects of causing drowsiness, but these tend to improve after taking the medication for a few days. Anti-inflammatories, such as Motrin and Aleve, may be helpful. They function to reduce the inflammation on the nerve, just as steroids do, but they are not as strong as a steroid. These medications thin the blood and can not be taken a week prior to any injection or surgery. Pain medications such as Percocet and Norco tend to not reduce nerve pain. These medications are often prescribed as they may take the edge off the pain but most people are surprised by how little they help.
- Injections: Spinal injections can help a pinched nerve, but are not helpful for pressure that is on the spinal cord and are typically not used to treat myelopathy.