Myelopathy

Myelopathy is a condition that results from compression of the spinal cord. The spinal cord is a structure that runs inside the spinal canal from the base of the skull to the upper portion of the lower back.

Myelopathy can occur in any part of the back where the spinal cord travels, but is most common in the neck, or cervical area of the spine.

At Neurosurgery One (formerly South Denver Neurosurgery), our neurosurgeons are experts at both surgical and non-surgical myelopathy treatment.


Risk Factors of Myelopathy

As you age, inflammation, arthritic illness, bone spurs, and the flattening and bulging of the spinal discs between the vertebrae can put pressure on the spinal cord, causing myelopathy. Myelopathy typically develops slowly as a result of the gradual degeneration of the spine, but it also can result from trauma or a malformation present at birth.

Some other common causes of myelopathy include:

  • Instability of elements within the spinal column
  • Spinal stenosis, a narrowing of the passageways of the spine through which the spinal cord travels
  • Spinal infections
  • Disc herniation and degeneration
  • Spinal cysts
  • Autoimmune disorders including rheumatoid arthritis

The following factors also can increase your risk of developing myelopathy:

  • Smoking
  • Advanced age
  • Excess weight or obesity
  • Participating in intense sports or physical activities, such as gymnastics or football
  • Inactivity
  • Repetitive, strenuous motions performed over prolonged periods
  • Improperly lifting heavy objects


Common Symptoms of Myelopathy

When the spinal cord is compressed or injured, it may cause a loss of sensation, loss of function, and pain or discomfort in the area at or below the compression point. Myelopathy symptoms may be associated with:

  • Neck, arm, leg, or mid back pain
  • Difficulty with fine motor skills, such as writing or buttoning a shirt
  • Increased reflexes in extremities or the development of abnormal reflexes
  • Difficulty walking
  • Loss of urinary or bowel control
  • Issues with balance and coordination
  • A heavy feeling in the legs causing an inability to move quickly
  • Muscle weakness

In many cases, symptoms will vary depending on where in the spine myelopathy is present. For example, myelopathy that occurs in the neck, or cervical area, is likely to cause symptoms in the neck and arms, including weakness, numbness, and tingling, but can include the legs as well.

Myelopathy that occurs in the middle back will produce symptoms below that area, including pain and cramping in the legs, but cannot affect the arms.


Non-Surgical Treatment for Myelopathy

Myelopathy is usually not treated with non-invasive therapy, because progression of any symptoms at diagnosis is not often reversible.  Therefore, surgical treatment is usually considered earlier than in other spinal conditions.  If your myelopathy is in the neck, your physician may recommend bracing to minimize movement that may result in increased pain.

Surgery to Relieve Pain from Myelopathy

At Neurosurgery One, our Denver spine surgeons generally take a conservative approach in other areas, but always recommend surgery for myelopathy. For myelopathy in the neck, or cervical area, those options include:

  • Laminectomy. In this procedure, a bone on the back of the spine that protects the spinal canal is removed in order to open up space in the spinal canal. However, most often the part of the spine causing a problem is in front of the spinal cord, so this is the best option for only a select group of patients. 
  • Anterior cervical decompression and fusion. This procedure involves removing a damaged disc to relieve spinal cord or nerve root pressure and alleviate corresponding pain, weakness, numbness, and tingling. A fusion surgery is done at the same time as the discectomy operation in order to stabilize the cervical segment. The procedure has an 90 to 95 percent success rate for pain reduction. Learn more about anterior cervical decompression and fusion, or ACDF.

When myelopathy has caused bone spurs or herniated discs, your surgeon may recommend the appropriate decompression surgery to relieve pressure on the spinal cord.

For advanced myelopathy caused by stenosis at many levels, without nerve involvement, your spine surgeon may recommend a surgical procedure called laminoplasty to increase the space within your spinal cord.