LUMBAR MYELOPATHY

Causes:

The causes of Lumbar myelopathy point to several factors, including age-related degeneration of the spine.

Additionally, herniated discs, spinal stenosis, spinal cord tumors, or traumatic spinal injuries also cause lumbar myelopathy. These conditions can lead to compression of the spinal cord, resulting in impaired nerve function and neurological symptoms.

Spinal Tumors and Bone Cancer

• Compression: Spinal tumors, including bone cancer, can exert pressure on the spinal cord. This compression disrupts normal nerve function, leading to myelopathy.

Cysts

• Arachnoid Cysts: These abnormal sacs filled with spinal fluid can form around the spinal cord, causing compression that leads to myelopathy.
• Synovial Cysts: Originating from the facet joints of the spine due to arthritis, synovial cysts can extend and compress the spinal cord, resulting in myelopathy.

Genetic Factors

• Genetic Disorders: Certain genetic disorders can predispose individuals to spinal cord malfunction, contributing to the onset of myelopathy.
• Nutritional Deficiencies: Poor nutrition can exacerbate genetic predispositions, further increasing the risk of spinal cord issues.

These factors highlight the complex interplay of physical and genetic elements that can lead to the development of myelopathy. Understanding these causes is crucial for effective diagnosis and management of the condition.

How Do Conditions Like Spondylosis and Spinal Column Inflammation Lead to Myelopathy?

Spondylosis plays a significant role in the development of myelopathy. As a degenerative arthritis affecting the spine, it can lead to severe issues by compressing the spinal cord. This compression often results from the presence of herniated discs or the formation of bone spurs. When these changes occur in the spine, they can disrupt normal neurological function, contributing to myelopathy.

On the other hand, Spinal Column Inflammation emerges as another contributor to myelopathy, especially in individuals with autoimmune disorders such as rheumatoid arthritis. The inflammation caused by these conditions can adversely affect the spinal column, leading to symptoms associated with myelopathy. This inflammatory response can exacerbate pressure on the spinal cord, further complicating its function and leading to potential neurological impairment.

Both conditions highlight the importance of understanding underlying spinal health issues and their implications for neurological well-being. Addressing these can be crucial in managing and potentially mitigating the progression of myelopathy.

Trauma’s Role in Myelopathy

Trauma, particularly spinal cord injury, plays a significant role in the development of myelopathy. Such injuries can lead to spinal cord dysfunction, exacerbating the onset of neurological impairments. When the spinal cord is injured, it can result in immediate or progressive dysfunction, highlighting the importance of recognizing trauma as a critical factor.

Understanding the Impact

• Compression: Traumatic injuries may compress the spinal cord, disrupting normal nerve signaling.
• Neurological Symptoms: This compression can manifest as pain, weakness, or loss of coordination, emphasizing the need for early intervention.

By understanding the multifaceted causes and impacts of myelopathy, especially the influence of trauma, we can better navigate treatment options and improve patient outcomes.

In patients over 50 years of age, several specific conditions contribute to myelopathy:

• Spondylosis: This arthritis of the spine can cause severe compression through herniated discs and bone spurs, particularly affecting older adults.
• Spinal Column Inflammation: Often associated with autoimmune diseases like rheumatoid arthritis, inflammation in the spinal column can develop into myelopathy.
• Spinal Tumors or Bone Cancer: Tumors can compress the spinal cord, leading to myelopathy. This is a critical consideration in older patients who may have a higher risk of such conditions.
• Cysts: Arachnoid cysts (abnormal spinal fluid sacs) or synovial cysts (arthritis sacs extending from the facet joint of the spine) can cause spinal cord compression.
• Genetics: Though less common, genetic factors and nutritional disorders can also lead to spinal cord malfunction, emphasizing the importance of a comprehensive medical evaluation.
• Trauma: Spinal cord injuries, whether from accidents or falls, are significant contributors to spinal cord dysfunction, especially in older adults whose bones and joints may be more susceptible to damage.

By understanding these varied causes, particularly in older patients, healthcare providers can better diagnose and manage lumbar myelopathy, enhancing the quality of life for those affected.

Symptoms:

Symptoms of lumbar myelopathy vary depending on the location and severity of spinal cord compression. This condition occurs from just under the belly button region to the mid-low back, leading to a distinct set of clinical presentations. Common symptoms include:

• Weakness or numbness in the legs
• Difficulty walking and maintaining balance
• Stiffness or pain in the lower back
• Changes in bowel or bladder function
• Muscle spasms

In severe cases, lumbar myelopathy can lead to paralysis or loss of sensation below the level of compression.

Interestingly, the clinical presentation of lumbar myelopathy is similar to that seen with thoracic myelopathy, which affects the spinal cord in the upper to mid-back region. This similarity can make diagnosis challenging, as both conditions exhibit overlapping symptoms. Understanding these nuances is crucial for effective treatment and management of myelopathy.

How it is Diagnosed:

Diagnosing lumbar myelopathy typically involves a combination of medical history review, physical examination, and imaging tests. Magnetic Resonance Imaging (MRI) is the preferred imaging modality.  An MRI provides detailed images of the spine, allowing doctors to visualize any compression or abnormalities of the spinal cord.

Risk Factors:

Several factors increase the risk of developing lumbar myelopathy.  They include age, genetics, occupations or activities that involve repetitive spinal movements or heavy lifting, obesity, and previous spinal injuries. Certain medical conditions such as arthritis or spinal tumors may also increase the risk of spinal cord compression.

Non-Surgical Treatment:

Non-surgical treatment options for lumbar myelopathy aim to alleviate symptoms and prevent further progression of the condition. This may include medications such as nonsteroidal anti-inflammatory drugs (NSAIDs) to reduce inflammation and pain, physical therapy to improve strength and mobility, and epidural steroid injections to reduce swelling and alleviate pressure on the spinal cord.

Surgical Treatment Details:

Doctors recommend surgery for severe cases of lumbar myelopathy that do not respond to conservative treatments or when there is a progressive neurological deficit. The surgical approach depends on the underlying cause of the myelopathy and may involve decompression surgery to alleviate pressure on the spinal cord, spinal fusion to stabilize the spine or tumor removal.

Complications:

Complications of lumbar myelopathy and its treatment may include persistent pain, recurrence of spinal cord compression, nerve damage, infection, or complications related to surgery. However, with proper evaluation, careful planning, and skilled surgical technique, doctors can lower the risks of complications and the benefits of treatment can outweigh the risks for many patients.

Physical Therapy Recommendations:

Physical therapy plays a crucial role in the management of lumbar myelopathy, focusing on improving strength, flexibility, and mobility to maximize function and quality of life. Therapeutic exercises, manual therapy techniques, and gait training can help alleviate symptoms, improve balance, and prevent falls.

Prevention Actions:

Although doctors cannot control age and genetics, certain preventive measures can help reduce the risk or delay the onset of symptoms. Maintaining a healthy weight, practicing good posture, avoiding activities that put excessive strain on the spine, and staying physically active with regular exercise can help preserve spinal health and reduce the risk of spinal cord compression.

Related Conditions and Types of Myelopathy:

Lumbar myelopathy is closely related to other spinal conditions such as cervical myelopathy (compression of the spinal cord in the neck), disc herniation, spinal stenosis, and degenerative disc disease. These conditions often coexist and may share similar symptoms and treatment approaches.

There are three primary types of myelopathy, each identified by the area of spinal cord compression:

• Cervical myelopathy
  This is the most common type and affects the cervical spine or neck region. Compression occurs between the skull and the top of the shoulders, along the first seven vertebrae. Symptoms can include compromised fine motor skills, balance issues, difficulty walking, numbness, tingling, pain, and weakness in the shoulders, arms, and hands. Additionally, individuals may experience trouble bending the neck, turning the head, or with eye-hand coordination.
• Thoracic Myelopathy
  Affecting the thoracic region from the top of the shoulders to just below the belly button, thoracic myelopathy is often caused by trauma, herniated discs, or arthritis. Symptoms can involve upper and mid-back issues such as balance trouble, weakness, heavy legs, unsteady walking, and even loss of bowel or bladder control and sexual dysfunction.
• Lumbar Myelopathy
  This occurs from compression in the lumbar region, spanning from just under the belly button to the mid-low back. The clinical presentation is often similar to thoracic myelopathy, highlighting the overlap and complexity of these spinal conditions.

Understanding the specific type and region of myelopathy is crucial for effective diagnosis and treatment, ensuring that related conditions are managed with precision and care.

How Does Cervical Myelopathy Affect the Body and What Symptoms Can It Cause?

Cervical myelopathy primarily impacts the neck, targeting the cervical spine. Compression in this region occurs between the skull and the uppermost part of the shoulders, specifically within the first seven vertebrae. This condition can significantly affect a person’s physical capabilities and daily functioning.

Effects on the Body:

• Motor Skills and Balance: One of the hallmark signs is a decline in fine motor skills. This can make it challenging to perform tasks that require precision, like buttoning a shirt. Additionally, balance issues and difficulty walking are common, which can increase the risk of falls.
• Sensory Issues: Numbness, tingling, and pain often manifest in the shoulders, arms, and hands, affecting the ability to carry out even simple activities.
• Neck Mobility: Many experience trouble bending their necks or turning their heads, which can complicate everyday activities like driving or reading.
• Coordination Challenges: Eye-hand coordination can suffer, making it difficult to perform tasks that involve coordination between sight and movement.

By understanding these symptoms, individuals can seek timely medical advice. Early intervention is crucial to managing the condition effectively and improving quality of life.

Living with the Condition:

Living with lumbar myelopathy requires ongoing management and lifestyle adjustments to alleviate symptoms and maximize function. Following a personalized treatment plan prescribed by healthcare providers, including medication, physical therapy, and assistive devices, can help improve mobility and quality of life.

Long-term Benefits of Treatment and Rehabilitation:

Effective treatment and rehabilitation can provide long-term benefits for individuals with lumbar myelopathy, including reduced pain, improved mobility, and enhanced quality of life. By addressing the underlying cause of spinal cord compression, relieving pressure on the spinal cord, and restoring function through rehabilitation, individuals can experience improved spinal health and overall well-being.

Choosing the Southwest Scoliosis and Spine Institute:

When seeking treatment for lumbar myelopathy, choosing the right healthcare provider is crucial for optimal outcomes. The Southwest Scoliosis and Spine Institute, led by renowned spine surgeons Doctors Richard A. Hostin, Devish Ramnath, and Ishaq Syed, offers comprehensive care and state-of-the-art treatments for spinal conditions, including lumbar myelopathy. With offices in Dallas, Plano, and Frisco, Texas, the institute provides personalized treatment plans tailored to each patient’s unique needs, ensuring the highest level of care and support throughout the treatment journey.

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National Library of Medicine: Lumbar Myelopathy