CERVICAL MYELOPATHY

Understanding the Difference Between Myelopathy and Radiculopathy

When navigating spinal health issues, it’s crucial to distinguish between myelopathy and radiculopathy. While they can occur together, these conditions have distinct differences:

Myelopathy:

• Cause: Myelopathy arises from compression of the spinal cord itself.
• Scope: This condition can impact the entire spinal cord, leading to potentially widespread symptoms.
• Symptoms: Individuals may experience issues such as difficulty in coordination, muscle weakness, and even problems with bowel and bladder control due to the extensive nature of spinal cord compression.

Radiculopathy:

• Cause: In contrast, radiculopathy is caused by the compression of a specific nerve root along the spine.
• Scope: It usually affects localized areas corresponding to the pinched nerve.
• Symptoms: Patients often report sharp pain, tingling, or numbness radiating along the nerve path, such as down an arm or leg, depending on the nerve root affected.

To summarize, while myelopathy involves widespread effects from spinal cord compression, radiculopathy is more localized, stemming from nerve root impingement. Recognizing these distinctions can aid in accurate diagnosis and targeted treatment.

Types of Myelopathy?

Doctors divide Myelopathy into three categories, and each one refers to the part of the spine that is afflicted. The three kinds are as follows:

• Cervical myelopathy. When the upper spine gets compressed, this condition develops.
• Thoracic myelopathy. Thoracic myelopathy occurs in the center of the spine In the upper and middle back.
• Lumbar myelopathy. Lumbar myelopathy occurs in the lower spine area.

The four regions of the Spine are as follows:

• The cervical or neck area (with vertebrae labeled C1-C7),
• The thoracic or upper back region (T1-T12),
• The lumbar or lower back region (L1-L5),
• The sacrum and coccyx, which are fused bones at the base of the spine

Cervical Myelopathy Causes

Cervical myelopathy is a progressive condition, meaning it tends to worsen over time if left untreated. The primary cause of this debilitating condition is spinal cord compression, which can occur due to several factors. Notably, severe cervical spondylosis—commonly referred to as cervical spondylotic myelopathy (CSM)—and ossification of the posterior longitudinal ligament (OPLL) are significant contributors. In OPLL, a critical ligament that connects the spinal vertebrae thickens and hardens, restricting spinal movement and function.

While some symptoms may temporarily improve with conservative treatments like physical therapy or medications, the underlying spinal compression usually requires more definitive treatment. The nerves that govern bodily motions and functions can become significantly impaired due to this compression. Because doctors cannot reverse nerve damage, it is critical to get treatment as soon as symptoms appear. Early detection and therapy can help you improve your health and, in some cases, reverse spinal cord injury. This makes understanding the specific causes behind spinal compression crucial, as it guides the therapeutic approaches and interventions necessary for effective management and recovery.

In addition to progressive wear and tear of the spine, cervical myelopathy can occur by hardening the ligaments covering the brain and spinal cord. Also, the posterior longitudinal ligament hardening occurs more frequently. Therefore. implying that the soft tissue that links the bones of the spine loses flexibility and gradually transforms into bone. As the ligament thickens, it takes up more space and exerts pressure on the spinal cord, resulting in this condition. The most prevalent site occurs in the neck region of the spine; however, any areas of the spine may become affected by disorders or degeneration, but aging provides the most common cause of cervical myelopathy.

The following spinal disorders can also cause cervical myelopathy

• Herniated cervical disc. A herniated disc can bulge or burst painfully. Pressure on the spinal cord or nerve roots may happen as a result of this.
• Rheumatoid arthritis. This autoimmune condition produces inflammation. The facet joints in the cervical spine can become damaged by inflammation, resulting in abnormal vertebral movement.
• Trauma. An abrupt injury, such as a vehicle accident or a sports collision, can cause the neck to hyperextend, compressing the spinal cord.
• Other cervical spine injuries, such as whiplash
• Spinal stenosis
• Spinal infections
• Spinal tumors and cancers

What happens when spinal stenosis is not treated

Understanding the progression from untreated spinal stenosis to myelopathy necessitates a review of the effects of prolonged spinal canal narrowing. When the spinal canal narrows and is left untreated, it exerts persistent pressure on the spinal cord. Over time, this continuous pressure leads to significant spinal cord trauma. Here’s a step-by-step breakdown of the process:
Ongoing Compression: As the canal narrows, the spinal cord is compressed. This compression disrupts the normal functioning of the spinal cord.

Impaired Blood Flow: The consistent pressure from stenosis diminishes the blood supply to the spinal cord. Without adequate blood flow, the affected portions of the spinal cord suffer from a lack of oxygen and essential nutrients.
Cellular Damage and Inflammation: The reduced blood flow leads to cellular damage. Dead and damaged cells trigger an inflammatory response. Inflammation, while a natural healing response, can exacerbate the situation by causing additional compression and damage if the underlying cause is not addressed.

Functional Impairment: The combination of reduced blood flow, cellular damage, and inflammation eventually impairs the ability of the spinal cord to transmit nerve signals effectively. These nerves are crucial for controlling movements and transmitting sensory information from the limbs to the brain.

In conclusion, untreated stenosis of the spinal canal can lead to myelopathy by causing physical compression of the spinal cord, reducing vital blood flow, initiating damaging inflammatory responses, and ultimately impairing the functions of the spinal cord. This series of events highlights the importance of treating spinal stenosis early to prevent severe damage and the onset of myelopathy.

Cervical Myelopathy Symptoms

The beginning of cervical stenosis with myelopathy may go unnoticed in the early stages. For example, a tiny difference in handwriting or taking longer to get ready in the morning may become too subtle to detect. Symptoms may become more obvious over time and may involve one or more of the following:

• Hand weakness or numbness can affect grip strength. Other regions of the body, such as the arms or legs, may also suffer from these sensations.
• Typing, handwriting, buttoning a garment, and placing a key in a door may all become more difficult for the person. 
• The legs may seem heavy, or the person may find it difficult to move faster. If the legs don’t move where they’re supposed to, balance issues might arise, necessitating the use of a walking cane and/or handrails.
• It’s possible that pain develops in the neck or that your range of motion becomes limited as walking becomes difficult with balance issues.
• Certain motions may cause the neck to create grinding noises termed crepitus.
• Intermittent electric-shock-like pain may radiate into the arms and legs, especially while bending the head forward (known as the Lhermitte phenomenon). Pain, tingling, weakness, and/or numbness may occur down the arm and/or into the hand if a nerve root also impinges.
• Loss of fine motor skills
• In severe cases, bowel or bladder dysfunction

Symptoms and their evolution emerge at different times for different people. Additionally, the rate at which symptoms worsen over time may also vary. Then symptoms may progress quickly for a while before settling down. Alternatively, the symptoms may appear gradually but consistently.

What are the Risks of Cervical Myelopathy?

The risks of cervical myelopathy include:

• Aging: Degenerative changes in the spine, such as herniated discs or bone spurs, are common causes of cervical myelopathy in older adults.
• Trauma: Injuries to the neck or spine can cause compression of the spinal cord.
• Genetics: Some people may have a genetic predisposition to developing cervical myelopathy.

Other spinal conditions: Conditions like spinal stenosis, disc degeneration, or tumors can contribute to the development of cervical myelopathy

Diagnosing Myelopathy

Myelopathy’s most prevalent symptoms are not specific to this disorder. Unfortunately, they often mistakenly indicate other diseases. To provide an accurate diagnosis, our doctors will conduct a physical exam and prescribe imaging testing to correctly diagnose this condition. 

Diagnostic Details

Myelopathy, a serious condition affecting the spinal cord, requires precise diagnosis and effective treatment. At the Southwest Scoliosis and Spine Institute, the initial step in the management of myelopathy involves a detailed diagnosis using state-of-the-art imaging technology. This advanced imaging technology allows skilled surgeons to identify and assess the extent of spinal cord compression accurately.

The doctor will begin by conducting a thorough medical history and performing a physical exam. They will ask about your symptoms, such as neck pain, weakness, or numbness, and any relevant medical history. During the physical exam, the doctor will check your reflexes, muscle strength, and sensation in your arms and hands.

To confirm a diagnosis of cervical myelopathy, the doctor will order imaging technology to look for signs of spinal cord compression or damage. These may include:

• X-rays: This imaging test uses radiation to create images of the bones in the neck, which can show if there are any abnormalities, such as bone spurs or a narrowed spinal canal.
• Magnetic resonance imaging (MRI): This test uses powerful magnets and radio waves to create detailed images of the spinal cord and surrounding tissues. An MRI can show compression or damage to the spinal cord.
• Computed tomography (CT) scan: This test uses X-rays and computer processing to create detailed images of the spine. It will display bony abnormalities, such as spinal stenosis.
• Electromyography (EMG) and nerve conduction studies evaluate nerve function and determine if the nerves in the neck or arms appear damaged.

Once a diagnosis of cervical myelopathy becomes confirmed, our doctors will work with the patient to develop an individualized treatment plan based on the symptoms and underlying cause of the condition.

How Can Myelopathy and Radiculopathy Be Diagnosed?

Diagnosing myelopathy and radiculopathy involves a careful and multi-faceted approach. Here’s how medical professionals typically proceed:

• Physical Examination: The process often begins with a thorough physical exam. During this assessment, doctors evaluate the patient’s mobility, strength, reflexes, and sensory response to detect any abnormalities.
• Symptom Analysis: Clinicians will also delve into the patient’s medical history and analyze symptoms such as pain, numbness, or weakness. This helps differentiate between the two conditions, as myelopathy usually affects the spinal cord, whereas radiculopathy impacts nerve roots.
• Diagnostic Imaging Tests:
• X-rays: Useful for visualizing bone structure, alignment, and any degenerative changes.
• CT Scans (Computed Tomography): Provides detailed cross-sectional images of the spine, helping to identify bone spurs or herniated discs.
• MRI (Magnetic Resonance Imaging): Offers the most comprehensive view of soft tissues, including the spinal cord and nerve roots, making it invaluable for diagnosing both conditions accurately.

By combining these steps, healthcare providers can distinguish between myelopathy and radiculopathy and tailor treatment plans to the precise needs of their patients.

Managing and Treating Myelopathy?

The two main types of treatments for cervical myelopathy are non-surgical and surgical procedures.

Customized Treatment Approaches

Following diagnosis, the medical team at The Southwest Scoliosis and Spine Institute designs a personalized treatment plan. This plan focuses on relieving the pressure on the spinal cord, a key factor in halting the progression of myelopathy and enhancing neurological function. The array of surgical procedures available at the Institute is targeted to precisely address the specific conditions causing spinal compression. Each technique aims to provide significant relief and improve the patient’s quality of life.

For decades, the expert spine surgeons at the Southwest Scoliosis and Spine Institute have been pioneering techniques that offer patients renewed hope and mobility. Their dedicated approach combines thorough diagnosis with innovative surgical treatments tailored to the unique needs of each patient.

Here’s a breakdown of the common non-surgical and surgical procedures:

Non-Surgical Procedures:

• Medications: Medications such as nonsteroidal anti-inflammatory drugs (NSAIDs), muscle relaxants, and corticosteroids manage pain and inflammation associated with cervical myelopathy.
• Physical therapy: Physical therapy will improve the range of motion, strengthen muscles, and relieve pressure on the spinal cord. This can help alleviate symptoms such as pain and weakness.
• Cervical traction: Cervical traction is a non-surgical procedure that uses a device to gently stretch the neck and relieve pressure on the spinal cord. This can help improve symptoms such as neck pain and tingling in the arms.
• Bracing: In some cases, a cervical collar or brace will help immobilize the neck and reduce pressure on the spinal cord.

Surgical Procedures:

• Anterior cervical discectomy and fusion (ACDF): ACDF is a surgical procedure that involves removing the damaged or herniated disc in the neck and fusing the adjacent vertebrae. This can help alleviate pressure on the spinal cord and improve symptoms such as pain and weakness.
• Cervical laminectomy: Cervical laminectomy is a surgical procedure that involves removing the lamina, or the bony arches of the vertebrae, to create more space in the spinal canal. For instance, this can help relieve pressure on the spinal cord and improve symptoms such as numbness and tingling in the arms.
• Artificial disc replacement: In this surgical procedure, the damaged disc in the neck is removed and replaced with an artificial disc. This can help maintain spinal flexibility and alleviate symptoms such as neck pain and stiffness.
• Posterior cervical laminoplasty: This procedure involves creating more space in the spinal canal by repositioning the vertebrae without removing the bone. This can help alleviate pressure on the spinal cord and improve symptoms such as numbness and weakness in the arms.

It’s important to note that the choice of treatment for cervical myelopathy depends on several factors. For instance, the severity of symptoms, age, general health, and underlying cause of the condition. Also, our doctors will assess all of these factors and recommend the most appropriate treatment for each patient.

What Treatments Are Available for Radiculopathy?

Radiculopathy, commonly referred to as pinched nerve pain, can be addressed through multiple treatment options, depending on the severity of the condition and the specific needs of the patient. Here’s a breakdown of available treatments:

Medication Options

• Pain Relievers: Non-prescription pain relievers like ibuprofen and acetaminophen can help alleviate mild to moderate discomfort.
• Prescription Medications: In more severe cases, doctors might prescribe stronger pain relievers or muscle relaxants.

Therapeutic Approaches

• Physical Therapy: A tailored physical therapy program can strengthen muscles, improve flexibility, and reduce pressure on the affected nerve.
• Chiropractic Care: Chiropractic adjustments may help relieve nerve compression and improve spinal alignment.

Surgical Interventions

• Microdiscectomy: This minimally invasive procedure involves removing portions of a herniated disc to relieve nerve pressure.
• Laminectomy: In this surgery, part of the vertebral bone called the lamina is removed to create more space for the nerve.
• Spinal Fusion: This procedure permanently connects two or more vertebrae, eliminating movement between them to reduce pain.
• Disc Replacement: An artificial disc replaces a damaged one, allowing more natural motion compared to a spinal fusion.

Alternative Treatments

• Acupuncture: Some patients find relief through acupuncture, which involves inserting thin needles into specific points on the body.
• Massage Therapy: Therapeutic massage can help alleviate muscle tension and reduce nerve compression.

Lifestyle Modifications

• Exercise: Regular, low-impact exercises, such as walking or swimming, can help maintain a healthy weight and reduce spinal pressure.
• Ergonomic Adjustments: Using ergonomic furniture and tools can help maintain proper posture and reduce strain on the spine.

Each treatment option comes with its own set of benefits and potential risks. It’s crucial to consult with healthcare professionals to determine the most appropriate course of action for your specific condition.

Cervical Myelopathy Advancements Or New Research

Surgical intervention, such as decompression or spinal fusion, is often necessary to alleviate pressure on the spinal cord and prevent further progression of symptoms. With timely and appropriate treatment, many people with cervical myelopathy can experience significant improvement in their symptoms and quality of life.

In addition to these established surgical approaches, recent research opens the door to potentially groundbreaking pharmacological treatments. The medication is currently being studied for its ability to aid spinal cord recovery after injury or surgery. Preliminary findings from animal studies suggest that this medicine may not only help the spinal cord recover from compression but could also be instrumental in enhancing recovery post-surgery. This promising avenue of research indicates that future treatment protocols could include a combination of surgical and drug therapies, aiming to optimize outcomes for patients with cervical myelopathy.

Further investigations are necessary to confirm the efficacy of this new medicine in human subjects. However, the integration of this medication into treatment strategies represents a significant potential advancement in managing and treating cervical myelopathy, offering hope for even better patient recovery experiences.

Myelopathy Prevention

Myelopathy is not always preventable. The condition is sometimes caused by typical aging, wear, and tear, and is avoided by strengthening and caring for your spine.  You can eliminate the potential of getting this condition by following the following hints:

• Lift heavy objects safely. Bend at the knees, tense your stomach muscles, and rise with your legs. Find someone to assist you if you can’t lift anything on your own.
• Maintain a healthy weight. The spine is strained even more by extra weight.
• Stop smoking. Smokers’ spinal discs degrade more quickly.
• Strengthen back and core muscles. Crunches, planks, and Pilates are exercises that can help.

The Prognosis for Myelopathy Patients?

Cervical myelopathy is a progressive condition, meaning it tends to worsen over time if left untreated. While some symptoms may temporarily improve with conservative treatments like physical therapy or medications, the underlying spinal compression usually requires more definitive treatment. The nerves that govern bodily motions and functions can become damaged by spinal compression. Because doctors cannot reverse nerve damage, it is critical to get treatment as soon as symptoms appear. Early detection and therapy can help you improve your health and, in some cases, reverse spinal cord injury.

Surgical intervention, such as decompression or spinal fusion, is often necessary to alleviate pressure on the spinal cord and prevent further progression of symptoms. With timely and appropriate treatment, many people with cervical myelopathy can experience significant improvement in their symptoms and quality of life.

The life expectancy of someone with cervical myelopathy is generally not significantly affected by the condition itself. However, untreated or severe cases of cervical myelopathy can lead to progressive neurological deficits and complications.  Complications can impact overall health and quality of life. Early diagnosis and appropriate treatment can help manage symptoms and improve outcomes.  However, it’s essential to consult with healthcare providers for personalized medical advice.

Why Choose the Southwest Scoliosis and Spine Institute

When you come to the Southwest Scoliosis and Spine Institute, you will find Experts and specialists who focus on diagnosing and treating scoliosis and other complex spine conditions including spine and revision surgery for children and adults. At our practice, we encourage people to get checked early on for neck pain.  In the majority of cases, our findings are minor. However, in certain cases, early detection and treatment can have a positive effect on future decades of a wonderful life. There are many reasons why you should choose the Southwest Scoliosis and Spine Institute to treat your lumbar spinal scoliosis. Here are a few:

• They have a team of experienced and board-certified surgeons who specialize in treating spinal conditions, including scoliosis.
• They offer a variety of treatment options, including non-surgical and surgical treatments.
• They have a state-of-the-art facility that is equipped with the latest technology for diagnosing and treating spinal conditions.
• They have a reputation throughout the Nation for providing the very best spinal care for their patients.
• They are conveniently located in three locations in Dallas, Plano, and Frisco, Texas

Finally, if you are considering treatment for cervical myelopathy, we urge you to schedule an appointment with the Southwest Scoliosis and Spine Institute. So pick up the phone today and give us a call. At the appointment, the doctors can help you understand your condition and develop a treatment plan that is right for you.

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National Institute of Health: Cervical Myelopathy