Myelopathy is an array of symptoms due to compression of spinal cord (superhighway) at the upper spine (Read more - Spine). In simple terms, the motorway is blocked, affecting the traffic in both directions (Read more- Spinal Motorway). The blood supply to the cord is compromised due to compression, and leads to cord damage and classical colour change on MRI.

MRI of the neck showing cord signal change (Red arrow) suggestive of myelopathy. This is an example of movement related compression rather than age related stenosis.

In the majority of cases, age-related degenerative changes are thought to be the case. Nevertheless, there are various other causes for compression of the cord, like tumour, infection and trauma. Some patients can have stenosis of both the upper and lower spine. It is similar to what happens in lumbar stenosis (Read More) , but in a different part of the spine.

The ability to perform hand functions, like opening jars, doing up buttons and to maintaining balance is affected. Patients often notice recurrent falls, describing their legs feel like jelly and difficulty in doing simple activity of daily living. It is thought to be a stepladder type progressive condition, whereby a period of stable symptoms is followed by sudden deterioration and further period of stable phase.

 

The most obvious question you might ask is “Will my condition progress?”

Cervical myelopathy is a progressive condition, and it is sometimes difficult to predict who will progress and who will not. It is believed about one fourth patients will have slow progression and rest will remain stable. The stable group of patients need to be kept under  close monitoring for the progression as it is difficult to predict. The group of patients who have progressive symptoms need evaluation and a further management plan needs to be drawn up.

Primarily the aim of the operative option is to release the pressure on the cord or the superhighway. The extent and method of this varies according to severity and nature of the compression. These surgeries may vary from ACDF (Read more) to laminectomy and so on.

Spinal Surgeon

Mr. N K Rath

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