Myelopathy is an injury to the spinal cord due to severe compression. Myelopathy is most common in the cervical spine, followed by cases involving the thoracic, or middle part, of the spine. Myelopathy in the lumbar spine (low back) is rare. The condition typically affects older adults.
Causes of Myelopathy
There are a number of causes for myelopathy. It may be the result of some type of trauma, such as an accident or fall, that causes a spinal injury. A tumor, cyst, or herniated disc may cause enough pressure to injure the spinal cord. Many cases occur gradually over time due to degenerative disease and spinal stenosis. Osteoarthritis and bone spurs may compress the spine, and some autoimmune diseases, including rheumatoid arthritis, can cause degeneration and damage to the spinal cord. Neurodegenerative diseases, such as Parkinson’s disease, can affect nerve function of the spinal cord. A small percentage of people are born with a spinal deformity or have congenital stenosis that results in a narrowing of their spinal canal.
Symptoms of Myelopathy
Symptoms depend on what part of the spine is affected. Cervical myelopathy may cause pain and stiffness in the neck. There may be pain, tingling, or numbness in the arms and hands, or problems with fine motor skills, and loss of manual dexterity. Symptoms of thoracic and lumbar myelopathy include mid or low back pain, leg pain, loss of coordination and balance, changes to reflexes in the extremities, difficulty walking, and loss of urinary or bowel control.
Diagnostic Tests
Since symptoms of myelopathy may mimic other spinal conditions, a thorough physical exam is a necessary part of the diagnosis. Imaging tests may include x-rays, an MRI, or CT Myelogram. The myelogram uses a contrast dye injected into the spine to allow the doctor to see the spinal canal, cord, and nerve roots. A myelogram is not recommended for pregnant women, patients with a history of seizures, and people taking blood thinners.
Treatments for Myelopathy
Conservative treatments may be used for mild cases of myelopathy. These nonsurgical options may include pain medications, spinal bracing, and physical therapy. These treatments can help relieve pain and may allow the patient to return to their daily activities. However, none of these nonsurgical treatments removes the compression, so the symptoms may continue to worsen.
Surgical treatment may depend on what is causing the myelopathy. One of the following surgeries may be helpful, depending on the patient’s specific issues.
- Spinal decompression surgery relieves pressure on the spinal cord.
- Spinal fusion can stabilize the spine and eliminate motion in the affected area.
- A neurosurgeon can remove bone spurs or herniated discs that may be causing a problem.
- A laminoplasty increases space in the spinal canal when there is spinal stenosis.
Minimally invasive techniques may be an option for some of these procedures.
Atlanta Brain and Spine Care
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