An Overview of Myelopathy

Updated on 2024-05-16 15:12:08 0 0

By Lana Barhum

Medically reviewed by Eva Umoh Asomugha, M.D.

Myelopathy is the result of an injury, neurological deficit, or inflammatory condition related to the spinal cord. Myelopathy can be cervical, thoracic, or lumbar, based on the part of the spine that is affected.

The term myelopathy actually refers to a cluster of symptoms as a result of spinal cord compression. This can occur when the spinal cord becomes compressed by bone fragments from a spine fracture, abscess, or ruptured disc.

Often times, the condition is missed or treated as a normal consequence of aging.

Because this condition can be progressive, early recognition and treatment is vital to improve outcomes before irreversible spinal cord damage has occurred.

nastya_ph / Getty Images

Symptoms and Types

The symptoms of myelopathy depend on the type and the extent of the spinal problem.

General symptoms include:

Weakness, muscle spasms or contractions, and clumsiness
Neck, arm, leg, or low back pain
Difficulty with fine motor skills, including writing or tying shoes
Increased reflexes and development of abnormal reflexes in the arms or legs
Problems with walking
Bowel and bladder issues
Sexual dysfunction

Cervical Myelopathy

Cervical myelopathy causes compression of the spinal cord in the cervical spine (neck). The cervical spine contains seven vertebrae—referred to as C1 to C7—with six vertebral discs and eight nerve roots.1

Cervical myelopathy is known to cause two types of symptoms: those in the neck and those appearing throughout the body at or below the compressed area in the spinal cord.2

Neck symptoms include pain and stiffness, and reduced range of motion. As the condition worsens, a person may experience shooting pain starting in the neck and traveling down into the spine.

Other symptoms of cervical myelopathy are:

Weakness of arms and hands
Numbness or tingling in the arms and hands
Clumsiness of and poor coordination in the hands
Balance problems
Problems with grasping small objects, such as a pen or coins

Cervical myelopathy is the most common type of myelopathy. The prevalence of surgically treated cervical myelopathy is 1.6 per 100,000 people, although researchers believe this number is much higher.2

Thoracic Myelopathy

Thoracic myelopathy causes the spinal cord in this area to be compressed from a bulging or herniated disc, bone spurs, or a trauma to the spine.

The thoracic region is the middle part of the spine. Thoracic myelopathy designates the location of the myelopathy. While the myelopathy originates in the thoracic region, it is possible for pain to be felt in other parts of the spine.

Symptoms experienced with thoracic myelopathy include pain and weakness in the legs and hands and problems with walking and balance.3 A person with this condition may also experience loss of bowel, bladder, or sexual function.

Because the symptoms of thoracic myelopathy aren’t unique and are seen with other types of myelopathy, testing is required to determine whether a person has thoracic myelopathy. This may include X-rays, nerve function testing, and/or magnetic resonance imaging (MRI) scans of the spinal cord and spinal canal.

Lumbar Myelopathy

Lumbar myelopathy is much rarer in comparison to cervical and thoracic myelopathy. It affects the lower part of the spine—the lumbar region.

It’s rare because the spinal cord ends at the top section of the lumbar spine. If someone has a low-lying lumbar spine, it can be affected by myelopathy. Symptoms are similar to the other two types.

Classification

Myelopathy can also be classified by the symptoms produced or by its underlying causes. For example:

A post-traumatic compressive myelopathy is often the result of some type of serious trauma. Research shows most are related to car accidents, violence, falls from heights, and sports injuries.4 These myelopathies tend to be more common in men, and may cause swelling and internal bleeding.
While rare, an abscess-related compressive myelopathy can progress rapidly if left untreated.4 Spinal epidural abscesses often occur in the thoracic or lumbar regions of the spine. These tend to be infection-related or related to the use of medical instruments. In many of these cases, a cause cannot be determined. Symptoms include severe back pain, tenderness in the affected areas, and fever. If the abscess is compressing the spinal cord, neurological symptoms—saddle anesthesia (loss of sensation in buttocks, perineum, and inner surfaces of the thighs), leg paralysis, and bladder and bowel problems—may develop.

Abscess-related compressive myelopathy requires rapid treatment to prevent and minimize permanent damage and neurological deficits. It is usually treated with antibiotics and/or surgery.

A myelopathy of vascular origin causes an abnormality in the spinal cord’s blood supply. The spinal cord’s blood supply can be affected by any compressive or non-compressive condition. Symptoms are similar to those of other myelopathies, especially neurological ones. Early detection and treatment are the best chance for neurological recovery.4

Causes

There are several causes of myelopathy, with the highest risk factor for the condition being age. As people age, inflammation, arthritis, bone spurs, and spinal discs put pressure on the spinal cord and its nerve roots.5

Myelopathy can either be acute or chronic. When the problem is acute, it comes on suddenly. Acute myelopathy can be caused by trauma to the spine or an infection to the spinal cord.6

Chronic myelopathy develops over a long time period. It can be caused by a variety of diseases and conditions, including:

Rheumatoid arthritis
A tumor on or near the spinal cord
Spinal stenosis
A neurodegenerative disease, such as amyotrophic lateral sclerosis (ALS) or Parkinson’s disease

Diagnosis

Pain is the most common reason people with myelopathy seek treatment.7 This may include neck pain, nerve pain in the arms and legs, and sometimes pain in the torso.

The symptoms of myelopathy are not unique and are seen in other conditions affecting the back, neck, and/or spine. Your healthcare provider will recommend specific testing to rule out other conditions and narrow down myelopathy.

Testing for a myelopathy diagnosis may include:

X-rays: X-rays can help to rule out other back, neck, and spine problems.
MRI scans: An MRI will offer a detailed look at the spine and the spinal cord, and look for inflamed and/or infected areas.
Myelography: A myelography uses a type of X-ray (called fluoroscopy) and the injection of contrast to evaluate the spinal cord, nerve roots, and spinal lining. It can reveal abnormalities in the spinal cord. Because it’s an invasive procedure and has risks, it is only used when MRIs aren’t helpful or cannot be done.8
Electrical tests: Tests, such as an electromyogram or somatosensory-evoked potentials, can help your healthcare provider see how well your nerves are providing feeling and movement in the arms and legs. These tests measure nerve movement in your hands, arms, legs, or feet through the spinal cord to the brain.

A diagnosis of myelopathy is communicated in a variety of ways.4 For example, the term “myelopathy” can be added to another diagnosis, such as “cervical stenosis with myelopathy.”

If the spinal cord is not involved, your healthcare provider may use the term “without myelopathy,” such as “displaced lumbar disc without myelopathy.”

If myelopathy is a complication of another disease, your practitioner may refer to it as it pertains to your disease, such as “diabetic myelopathy,” meaning that diabetes has caused damage to the spinal cord.

Treatment

Goals for treating myelopathy involve reducing pain and improving a person’s ability to function and carry on with normal, day-to-day activities. Most of the time, this is done through nonsurgical approaches.

When symptoms of myelopathy continue or worsen despite nonsurgical therapies, your healthcare provider may suggest surgical intervention.

Nonsurgical Treatment

Many nonsurgical treatments can be just as effective as surgery for reducing pain and easing symptoms of myelopathy.2 Usually, these measures are effective and may reduce the need for surgery, or in the least, delay surgery until absolutely necessary.

Nonsurgical treatments are usually helpful when myelopathy is caused by swelling or inflammation in the spinal canal.

Nonsurgical treatments may include:

Pain relievers: Mild cases of myelopathy may respond to pain management. This may include the use of over-the-counter (OTC) pain relievers, including acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs). Your healthcare provider can prescribe stronger pain relievers as needed.
Physical therapy: In some cases, poor posture contributes to myelopathy.9 This can lead to back and neck muscle pain and weakness, causing the spinal cord compression. Physical therapy can be helpful for reducing pain and improving function in these instances. A physical therapist can also make recommendations for modifying activities and avoiding certain motions and positions that trigger pain and discomfort in the spinal cord.
Steroid injections: In some cases, swelling of the spinal cord can be treated with cortisone injections. Cortisone is a type of steroid designed to resemble and affect the body in the same way cortisol (a natural pain-relieving substance in the human body) does. Injections are given directly in the epidural space within the spine. Steroid injections may take days to take effect and should be used sparingly.

Surgery

For cases of moderate to severe myelopathy or cases where nonsurgical treatments don’t help, your healthcare provider may recommend surgical treatment. Surgeries that can alleviate myelopathy remove pressure from the spinal cord and open up more space for the spinal cord within the spinal canal.

Three surgeries commonly used for treating myelopathy are:

Spinal fusion: Spinal fusion surgery corrects problems in the small bones of the spine. This involves fusing together two or more vertebrae, so they can heal into a single solid bone. Doing this can reduce painful motions and restore stability to the spine.
Laminectomy: In a laminectomy, the surgeon removes the bony arch of the spinal canal—called the lamina—and any bone spurs and ligaments that are compressing on the spinal cord. The laminectomy relieves pressure on the spinal cord by providing space for the spinal cord to shift back. A laminectomy is usually done with a spinal fusion using bone grafts, screws, and rods. The reason this is done is because the laminectomy leaves the spinal cord less stable.
Laminoplasty: A laminoplasty is an alternative to a laminectomy where the lamina is thinned out on one side and then cut on the other side. This creates a hinge, which expands the space for the spinal cord and allows the healthcare provider to address any spine levels that may be compressed. This procedure can help to preserve up to 50% of the motion in the affected spine areas.10

Regardless of the treatment approach for myelopathy, your healthcare provider’s plan will be to decompress the spinal cord and prevent neurological problems. Another goal will be to reduce neck pain and current neurological symptoms.

Outcomes will vary from person to person, but most people show improvement with nonsurgical options, and if there isn’t any improvement, surgery can be beneficial.

Neck and back pain are common ailments experienced by most people. Sometimes pain develops suddenly, such as with an injury, and other times it is a result of years of poor posture or wear and tear.

While most of the time, neck or back pain isn’t serious, there are instances where it can be. You should talk to your healthcare provider if you experience pins and needles in your arms and legs, in addition to neck or back pain; if you a have a fever; or if pain worsens when you sit down.

If you are having any problems with urinating or moving your bowels, and you are experiencing back pain, you should talk to your healthcare provider right away.

These are signs of a very serious condition where the nerves at the bottom of the spinal cord—called the cauda equina—become damaged. Cauda equina syndrome is considered a medical emergency and requires urgent surgical treatment.11

Fortunately, cauda equina syndrome is rare, and most people who experience neck, back, and spine symptoms rarely need surgery, and symptoms can be managed with nonsurgical therapies and at-home care.

Of course, anytime neck, back, or spine symptoms get worse or you are having a hard time performing daily activities, make sure you make an appointment to see your healthcare provider.

Sources

American Association of Neurological Surgeons. Cervical spine.

Donnally III CJ, Hanna A, Odom CK. Cervical myelopathy. StatPearls.

Nagal A, Johnson, D. Thoracic radiculopathy/myelopathy. American Academy of Physical Medicine and Rehabilitation.

Granados Sánchez AM, García Posada LM, Ortega Toscano CA, López López A. Diagnostic approach to myelopathies. Rev Colomb Radiol. 2011;22:(3):1-21.

Cleveland Clinic. Spine anatomy.

Kranz PG, Amrhein TJ. Imaging approach to myelopathy: acute, subacute, and chronic. Radiol Clin North Am. 2019;57(2):257-279. doi:10.1016/j.rcl.2018.09.006

Davies BM, Mowforth OD, Smith EK, Kotter M. Degenerative cervical myelopathy. BMJ. 2018;360:k186. doi:10.1136/bmj.k186

Butler JS, Oner FC, Poynton AR, O’Byrne JM. Degenerative cervical spondylosis: natural history, pathogenesis, and current management strategies. Adv Orthop. 2012;2012:916987. doi:10.1155/2012/916987

Alekseyev K, Thampi S, Ozurumba N, Udani J, Lakdawala M. A case report of silent cervical spondylotic myelopathy without neck pain. Ann Clin Lab Sci. 2016;4:2.

American Academy of Orthopaedic Surgeons. Cervical spondylotic myelopathy: surgical treatment options.

American Association of Neurological Surgeons. Cauda equina syndrome.