Myelopathy is the result of a condition that compresses the spinal cord and affects nerve functions. This article will explore the causes, symptoms, diagnosis, and treatment of myelopathy.
What Is Myelopathy?
Your spinal cord runs all the way down from the base of the brain to the lower back. The spinal canal, which consists of tissues, cartilage, and bone, covers the spinal cord and is tasked with protecting it from impact. The primary task of the spinal cord is relaying information from the brain to different body parts and regulating motor and sensory functions.
Myelopathy is a spinal cord injury that affects communication between the brain and other body parts. This most often happens when the spinal cord is compressed.
Myelopathy is sometimes confused with myopathy, but the two are distinct conditions that affect different body parts. While myelopathy affects the nerves in the spinal cord, myopathy affects your muscles.
Myelopathy is grouped into different types based on the part of the spinal cord it affects.
- Cervical myelopathy. This condition affects the nerves in the cervical region of the spinal cord, near the neck.
- Thoracic myelopathy. Thoracic myelopathy affects the nerves in the thoracic region of the spinal cord (i.e., the middle and upper back).
- Lumbar myelopathy. As the spinal cord usually doesn’t extend to the lumbar spine, this condition occurs rarely. That said, it can sometimes affect the nerves in the lower region of the spine (near the base of the torso).
Spinal cord compression may occur due to several factors. Arthritis and spondylosis are two of the most common culprits. They can cause the vertebrae (bones in the spine) to slowly degenerate. When the bones in the upper part of the spine (cervical region) are affected, the resulting condition is called cervical spondylotic myelopathy. It damages the nerve fibers of the spinal cord and blocks nerve impulses that would normally be sent to your arms, legs, and other body parts. This leads to weakness and pain.
Myelopathy can also be caused by a bone fragment sticking out from the spine and pressing on one or more nerves, causing pain and reducing your ability to move specific body parts. This condition could appear suddenly (acute myelopathy) or progress over time (chronic myelopathy). Acute myelopathy usually occurs due to a major impact, such as a fall. On the other hand, existing disorders such as rheumatoid arthritis, spinal tumors, or neurodegenerative diseases like Parkinson’s disease and amyotrophic lateral sclerosis (ALS) could all cause chronic myelopathy.
Symptoms of myelopathy include:
- Pain or a loss of sensation and function in the affected area
- Pain in your neck, arms, legs, and lower back
- An imbalanced gait
- Inability to coordinate bodily movements
- A tingling sensation or numbness in the affected area
- Difficulty with fine motor skills like writing or tying your shoelaces
- Inability to control urination and bowel movements
When diagnosing this condition, doctors typically begin with a physical examination and check your medical history. Since myelopathy symptoms are similar to a few other conditions, your doctor may carry out additional tests to confirm the diagnosis:
- X-ray. This test rules out other conditions that could lead to spinal cord compression.
- Magnetic resonance imaging (MRI) scan. An MRI scan is one of the best ways to get clear images of the spinal cord, spinal canal nerve roots, intervertebral discs, and ligaments. It identifies signs of compression in the spinal cord.
- Myelography. This test utilizes a type of real-time x-ray called fluoroscopy, along with a material that offers a contrast (typically a dye) to indicate any irregularities in the spinal cord. Doctors typically recommend this test if you can’t use an MRI machine.
- Torg ratio. Sometimes, doctors use this test to measure the diameter of the spinal canal and detect spinal cord compression.
- Other tests. Certain electrical tests like an electromyogram can establish whether or not limbs are capable of moving properly. These tests stimulate the nerves, regulating arm and leg movements to test their functions.
Your doctor may reach a diagnosis based on several factors. For instance, if your spinal cord compression is due to an existing condition such as diabetes, your doctor might tell you that you have diabetic myelopathy.
Treatment for myelopathy depends on the type of the condition, its complexity, and what has caused it. Your doctor weighs all options and determines the best way forward based on your specific symptoms and how advanced your condition is.
For example, antibiotics treat bacterial infections that cause spinal cord compression. Their elimination can decompress the spine, thus relieving the pressure on the nerve fibers and curing your myelopathy.
Meanwhile, keeping the cervical bones fixed using a brace can reduce pressure on the spinal cord. Although it’s not a cure, this treatment reduces pain and prevents the condition from worsening. Physical therapy exercises are another way to relieve pressure on the spinal cord.
Non-steroidal anti-inflammatory drugs are capable of reducing pain and other symptoms. Sometimes, your doctor may inject steroids into the affected area to ease the pain.
Doctors usually recommend surgery when the condition deteriorates to the point that it causes a loss of bladder or sphincter control. Surgery is also often the best option to remove tumors and bone fragments. In many cases, this provides permanent relief and enhances your quality of life.
Surgical methods may include:
- Laminectomy. This surgery involves removing bone fragments in the spinal canal (the lamina) that may be causing spinal cord compression. It relieves pressure and allows the spinal cord to return to its original position.
- Laminoplasty. When a laminectomy is not possible, doctors opt for a laminoplasty. This involves eroding the lamina on one side and cutting it away completely from the other side, creating a hinge that creates space for the spinal cord to expand to its original position. Doctors only perform laminoplasty on the spinal bones in the neck.
- Spinal fusion. This involves fusing two or more vertebrae to form a single bone, stabilizing the spine. This will minimize the pain you experience.
Spinal cord compression can cause irreversible nerve damage and lead to loss of foot and arm movements, so identifying myelopathy in the early stages is critical for proper recovery (including the potential reversal of spinal cord damage).