Cervical myelopathy results from severe compression on the spinal cord. It is a common degenerative disorder, characterized by clumsiness in the hands and gait imbalance.
This condition is progressive and is mainly due to pressure on the cervical spinal cord., as a result of bone marrow deformation by anterior herniated discs, spondylitic spurs, an ossified posterior longitudinal ligament or spinal stenosis.
Myelopathy is typically a gradual degenerative process that affects older adults..
It can be the cause of a wide variety of signs and symptoms. The onset of this disease is insidious, typically in people of 50 a 60 years.
Index
Causes of Cervical Myelopathy
Myelopathy usually develops slowly as we age, but it can also come from a spinal deformity present at birth. Common causes of myelopathy are degenerative vertebral conditions such as:
- Spinal stenosis
- narrowing of the bony passages of the spine and nerve roots
- Rheumatoid arthritis
- Cysts
- Hematomas
- Tumors
- Bone cancer
- Spinal injuries and infections
- Inflammatory diseases
- Radiotherapy
- Neurological disorders
Chronic cervical degeneration is the most common cause of progressive compression of the spinal cord and nerve root.. The causes of cervical myelopathy can be divided into different categories:
Static factors
These are usually due to a narrowing of the size of the spinal canal and degenerative changes in the anatomy of the cervical spine., What: disc degeneration, spondylosis, stenosis, osteophyte formation, segmental ossification, etc.
Dynamic factors
These factors are the consequence of mechanical abnormalities of the cervical spine or instability.
Vascular and cellular factors
Among the factors of this type we have: spinal cord ischemia affecting oligodendrocytes, resulting in demyelination that exhibits characteristics of chronic degenerative disorders. Glutamatergic toxicity can also occur, cell injury and apoptosis.
Symptoms
Symptoms generally develop slowly. Due to lack of pain, there may be an interval of years between the onset of the disease and the first treatment.
Los síntomas tempranos de esta afección son “manos adormecidas, torpes y dolorosas” y alteración de las habilidades motoras finas.
When the spinal cord is compressed or injured, can cause loss of sensation, loss of function and pain or discomfort in the area at or below the point of compression.
The exact symptoms will depend on where the myelopathy is present in the spine.. For instance, cervical myelopathy has symptoms in the neck and arms.
Symptoms of myelopathy can include:
- Neck Pain, arm, leg or lower back
- Distal weakness
- Tingle, numbness or weakness
- Clumsy or weak hands
- Difficulty with fine motor skills, like writing or buttoning a shirt
- Increased reflexes in the extremities or the development of abnormal reflexes
- Dificulty to walk
- Radiculopathic signs
- Loss of urinary or bowel control
- Common occipital headache
- Problems with balance and coordination
- Axial neck pain
Diagnosis
To diagnose the presence of cervical myelopathy, specialists recommend a detailed and thorough neurological exam plus an MRI or MRI. Plain radiographs alone are of little use as an initial diagnostic procedure.
An MRI image (IRM) considered the best imaging method to confirm the presence of spinal canal stenosis, umbilical cord compression or myelomalacia, items related to cervical spine myelopathy.
Myelography is also of great help, uses a contrast material and a form of x-ray called real-time fluoroscopy to reveal abnormalities of the spinal cord. Sometimes used instead of MRI for patients who cannot be inside a machine.
Treatment
Treatment of cervical myelopathy depends mainly on its causes. Nevertheless, in some cases, the cause may be irreversible. In this case, the treatment may only be to relieve the symptoms or slow down the progression of this disorder..
Treatments for this condition can be divided into surgical and non-surgical..
Non-surgical treatment of cervical myelopathy
Non-surgical treatment for cervical myelopathy may include bracing, physical therapy and medications. These treatments can be used for minor conditions and are intended to reduce pain and help you get back to your daily activities..
Non-surgical treatment does not eliminate compression. Your symptoms will progress, usually gradually, but sometimes sharp, in some cases. If you notice progression of your symptoms, talk to your doctor as soon as possible.
Surgical treatment of cervical myelopathy
Spinal decompression surgery is a common treatment for cervical myelopathy. Surgery may also be used to remove the bone spurs waves herniated discs if they are found to be the cause of the myelopathy.
Laminoplasty is a motion-saving surgical procedure, meaning your spinal cord remains flexible at the site of compression.
Some patients may not be candidates for a laminoplasty. Another alternative is decompression and spinal fusion that can be done earlier. (from the front) the later (from the back).
While waiting for surgery, a combination of exercise, Changes in lifestyle, hot and cold treatments, injections or oral medications can help you manage any pain symptoms.