Cervical Myelopathy

Overview

Definition

Cervical myelopathy is damage to the part of the spinal cord that is in the neck. The cervical spine begins at the base of the skull. It extends to the first seven vertebrae.

Cervical Spine
Cervical Spine
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Causes

Cervical myelopathy is caused by:

  • A slipped disc
  • Cervical discs that are worn, known as degeneration
  • Tumors inside the spinal cord or compressing on the spinal cord
  • Bone spurs
  • Dislocation or fracture of the neck
  • Traumatic injury to the cervical spine
  • Autoimmune disease, such as transverse myelitis, multiple sclerosis, or neuromyelitis optica

Risk Factors

Factors that may increase your risk of 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

SymptomsandDiagnosis

Symptoms

Symptoms may include:

  • Pain in the shoulder and arms
  • Tingling or numbness in the arms and legs
  • 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
  • Weakness below the waist or in all 4 limbs

Diagnosis

You will be asked 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

Imaging tests evaluate the spine and surrounding structures. These may include:

  • X-ray
  • MRI scan
  • CT myelogram

Other tests may include:

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

Treatments

Treatment

Talk with your doctor about the best treatment plan for you. This may involve:

  • Treating the cause of the myelopathy
  • Improving functions that you have lost
  • Reducing or managing pain
  • Doing strengthening exercises
  • Teaching you ways to reduce injuries
  • Helping you learn ways to cope with the condition

Surgery

If there is structural pressure on the spinal cord, you may need surgery right away. This is to attempt to avoid lasting injury. There are many different kinds of surgery and procedures to stabilize the neck, such as:

  • Discectomy—to remove part of an intervertebral disc that is putting pressure on the spinal cord or nerve root
  • Laminectomy—a surgical procedure to remove a portion of a vertebra, called the lamina
  • Fusion of the vertebrae
Cervical Fusion
Sagittal View of a Cervical Fusion
Screws and a plate prevent the vertebrae from putting pressure on the spinal cord.
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Nonsurgical Approaches

Nonsurgical approaches may include:

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

Medication

Medications may help to relieve symptoms. Common medications include:

  • Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen
  • Corticosteroids
  • Rituximab—This is an antibody used to treat some autoimmune disorders.

Other medications that affect the immune system are also sometimes used.

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 disc 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 the stairs and your bed.
    • Install handrails in the tub and shower.
    • Rise slowly from a seated or lying position.

This content is reviewed regularly and is updated when new and relevant evidence is made available. This information is neither intended nor implied to be a substitute for professional medical advice. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with questions regarding a medical condition.

Edits to original content made by Denver Health.

a (Myelopathy, Cervical)

RESOURCES

National Institute of Neurological Disorders and Stroke http://www.ninds.nih.gov 

United Spinal Association http://www.spinalcord.org 

CANADIAN RESOURCES

Canadian/American Spinal Research Organizations http://www.csro.com 

Health Canada https://www.canada.ca 

References

Cervical myelopathy. Johns Hopkins Medicine website. Available at: https://www.hopkinsmedicine.org/healthlibrary/conditions/adult/orthopaedic%5Fdisorders/CervicalMyelopathy%5F22,CervicalMyelopathy. Accessed November 8, 2017.

Lumbar spondylolysis. EBSCO DynaMed Plus website. Available at:  http://www.dynamed.com/topics/dmp~AN~T116565/Lumbar-spondylolysis . Updated July 16, 2015. Accessed November 8, 2017.

Older adult falls. Centers for Disease Control and Prevention website. Available at: http://www.cdc.gov/homeandrecreationalsafety/falls/index.html. Updated October 11, 2016. Accessed November 8, 2017.

Pollard H, Hansen L, Hoskins W. Cervical stenosis in a professional rugby league football player: a case report. Chiropr Osteopat. 2005;13:15.

Young WB. Clinical diagnosis of myelopathy. Semin Ultrasound CT MR. 1994;15(3):250-254

Young WF. Cervical spondylotic myelopathy: a common cause of spinal cord dysfunction in older persons. Am Fam Physician. 2000;62(5):1064-1070.