What is Myelopathy?

Myelopathy is a condition caused by compression of the spinal cord. It can result in weakness, numbness, pain, loss of balance and a wide array of other symptoms. It most often occurs in the cervical spine (neck), but can sometimes be found in the lumbar spine (lower back) or thoracic spine (mid back).

Myelopathy is often a complication of a condition called spondylosis, which is the breakdown of intervertebral discs. Spondylosis with myelopathy means that the discs are degenerating and causing pain.

Myelopathy vs Radiculopathy

Myelopathy is sometimes confused for and misdiagnosed as a condition known as radiculopathy. While myelopathy is compression of the spinal cord itself, radiculopathy is compression of the nerve roots that branch off from the spine and run to other parts of the body.

Radiculopathy causes pain that radiates to other parts of the body. Sciatica, a compression of the nerve roots that become the sciatic nerve in the buttocks that causes pain in the legs, is an example of a radiculopathy condition.

What Causes Myelopathy?

Myelopathy is caused by compression of the spinal cord. There are many reasons that the spinal cord may become compressed. Some of the more common reasons are:

• Intervertebral disc herniation
• Spinal stenosis, a narrowing of the spinal canal caused by arthritis
• Spinal tumors
• Injury to the spine
• Autoimmune conditions like rheumatoid arthritis

What are the symptoms of myelopathy?

Symptoms of myelopathy will depend on where and how badly the spinal cord is compressed. People with myelopathy, in general, can expect to experience:

• Pain in the neck, arms, legs or lower back
• Numbness
• Tingling
• Weakness
• Difficulty with fine manipulation or motor skills
• Abnormal reflexes
• Bladder or bowel incontinence in severe cases
• Difficulty with balance and coordination
• Myelomalacia, a softening of the spinal cord

How is myelopathy diagnosed?

A diagnosis of myelopathy requires localizing the area of spinal cord compression. If there is no compression of the spinal cord itself, the condition can be diagnosed as something else, such as a form of radiculopathy or other non-surgical condition.

Imaging studies are crucial in diagnosing myelopathy. Magnetic resonance imaging (MRI) scans are the main way to diagnose myelopathy. CT scans are also used. X-rays do not show the soft tissue of the spinal cord and therefore cannot be used to diagnose the condition, but they can be useful in ruling out other conditions.

Other diagnostic tools include tests to measure nerve function, as well as myelography, which uses a contrast die and a special type of X-ray called fluoroscopy to show spinal abnormalities.

How can myelopathy be treated?

Treatment for myelopathy largely depends on the underlying cause. Nonsurgical treatment such as medication, bracing and physical therapy can be helpful to control the symptoms of mild myelopathy. Often, nonsurgical treatment will not remove the source of the spinal compression and therefore will not be able to cure myelopathy.

There are a variety of surgical treatments available to treat the underlying causes of myelopathy.

• A microdiscectomy can take pressure off the spinal cord by removing a herniated disc.
• Spinal stenosis can also be treated with a laminectomy, which is when surgeons remove a small piece of vertebra called the lamina, to open up the spinal canal and allow the spinal cord to move away from whatever was compressing it. This may be performed with or without a spinal fusion.
• A spinal fusion is another possible treatment for myelopathy. After the spinal cord is decompressed, surgeons create an environment using bone grafts and metallic hardware that encourage vertebrae to grow together.

It is best to seek treatment for myelopathy as early as possible. Long-term compression of the spinal cord can lead to permanent damage. In such cases, the condition causing the myelopathy will be unable to be cured. However, treatment can still help by focusing on managing symptoms and preventing the condition from getting worse.

 Our experts at Neurosurgical Associates are widely experienced in diagnosing and treating myelopathy in all areas of the spine and at all stages of severity. To learn more about your treatment options, request an appointment.