What is Myelopathy?
What is Myelopathy?
Myelopathy is the result of compression of the spinal cord, often in the cervical area of the spine. The compression of the neck portion of the spine can cause problems with fine motor skills, pain in the neck, loss of balance and trouble walking.
What Causes Cervical Myelopathy?
The most common causes of cervical myelopathy is age related inflammation, arthritis and associated symptoms such as bone spurs and the flattening of the spinal discs. Though usually the gradual degeneration of the spine, also known as spondylosis, is the cause of myelopathy is can also occur as a result of an injury.
Spinal stenosis is the narrowing of bony pathways in the spine where the spinal cord and nerves run through. Stenosis can occur with age and rheumatoid arthritis.
Degenerative Myelopathy and Spinal Cord Compression
Another cause of myelopathy is disc herniation, which is pressure on the spinal cord through a bulging spinal disc. Herniated discs happen over time as the spinal discs wear out and the outer wall becomes weak, which allows the inner nucleus to bulge and put pressure on the surrounding nerves. Though they can also be caused by a traumatic injury such as a car accident or sports injury.
The compression of the spinal cord causes neck pain, tingling, numbness weakness, and difficulty with fine motor skills like writing. You may also experience difficulty walking, or loss of balance and coordination. Cervical myelopathy symptoms may extend from the neck into the arms depending on the cause and severity.
Diagnosis of Myelopathy
In order to properly diagnose myelopathy there may be a few tests to ensure the correct analysis. An MRI scan is uniquely well suited to see what’s going on inside and around the spine to see what is causing any pain or discomfort. X-Rays may also be used to rule out other issues or a pyelography for patients who can’t be inside an MRI machine. Myelography is a form of X-ray that uses a contrasting material and a fluoroscopy to view what’s happening to the spinal cord.
Treatment for Myelopathy
There are a few paths to treatment when it comes to myelopathy. Depending on the cause of the myelopathy there may be treatment of symptoms, or an intervention to reverse the cause or slow the progression of the disorder.
Treating Myelopathy Symptoms
When the symptoms are mild non-surgical myelopathy treatments may be preferred. These include physical therapy, medication, and bracing. Though these don’t decompress the spine, so it is usually good to treat the underlying cause of the myelopathy.
The most common surgical procedures to treat myelopathy are cervical discectomy and fusion, laminectomy and laminoplasty. The surgery can be approached from the front of the neck, or the back of the neck, called anterior and posterior respectively. Both sides can also be used if needed to help with the compression and spinal instability. Your doctor will discuss all the approaches and risks and benefits of each.
Spinal fusion to treat myelopathy basically stabilizes the spine by fusing two or more vertebrae together with a bone graft. The motion between the vertebrae will be removed, and so this should remove the cause of the pain, which may have been pinching of nerves through misaligned bone structures. In many cases of spinal fusion some hardware will be placed along the vertebrae being fused to help spinal fusion occur. These are metallic plates, rods, and screws which also help stabilize the spine and allow the bone graft to heal and fuse the bones.
Discectomy and Microdiscectomy
The discectomy surgery removes herniated disc material that compresses the spinal cord. Microdiscectomy uses a microscope to view the discs and nerves which lets the surgeon use smaller incisions and cause less damage to surrounding tissue.
Laminectomy for Myelopathy
A laminectomy removes the protruding bone on the backside of the spinal canal, as well as bone spurs that are compressing nerves in the spine. This allows the spinal cord decompression and relieves pain, but since bone is removed the vertebrae becomes less stable, so spinal fusion is often performed alongside a laminectomy.
What is a Laminoplasty?
The laminectomy and Laminoplasty have similarities in that they are both operating on the lamina, but the Laminoplasty doesn’t remove the lamina entirely. Instead, it cuts one side and thinned on the other to allow the lamina area to open on a hinge-like axis. The opening of the lamina creates space for the spinal cord and decompresses the nerves. The benefits of a laminoplasty are that is preserves 30 to 50 percent motion in the operated area, though this doesn’t guarantee the spinal canal will be totally open for the spinal cord, and the opened hinge can eventually close.
Myelopathy Surgery Recovery
Depending on which surgery is performed, and the overall health of the person undergoing surgery, the at home recovery length can be anywhere from a few days to a few weeks. Full range of activities such as bending or lifting something heavy can take a bit longer, possibly between 3 and 4 months.
To understand more about myelopathy and any causes unique to your symptoms you should speak to your doctor. Neurologists and neurosurgeons will be able to give you accurate information after an assessment and diagnosis.