Cervical Myelopathy

Cervical Myelopathy Treatment

Cervical Myelopathy is affection of cervical spinal cord causing various neurological symptoms. This usually happens with chronic cervical spondylosis leading to progressive disc bulge, osteophyte formation and ligamentum flavum hypertrophy causing cervical spinal stenosis. It’s called Spondylotic Cervical Myelopathy. Some patients have narrowing of spinal canal since birth and are prone to develop these symptoms early (Congenital Spinal Stenosis). Ossification of ligaments of cervical spine is also common cause of cervical myelopathy. External pressure caused by spinal infection, fracture and tumor can also cause symptoms of cervical myelopathy.


Cervical Myelopathy

Cervical Myelopathy Symptoms:

Cervical myelopathy will affect the neurological supply to both upper and lower extremities and part of the body below the level of cervical spinal cord compression.

  • Tingling, numbness, weakness in upper extremity.
  • Loss of grip and clumsiness of hand.
  • Loss of body balance.
  • Difficulty in walking, standing, sitting.
  • Loss of bladder-bowel control.
  • Spasticity in the extremities and body.

Cervical Myelopathy Diagnosis:

  1. Typical history and physical examination,
  2. MRI Scan: Main diagnostic tool which will show level and severity of pressure on spinal cord,
  3. X-rays: to rule out bone abnormalities and instability,
  4. CT Scan: A CT might be required to assess bone structure in detail, especially for patients suspected to be having ossified ligaments. Also, CT is recommended when MRI cannot be done (patients with heart pacemaker, ear cochlear implants, certain stainless steel orthopaedic implants),
  5. EMG-NCV: In cases where there is mismatch between MRI picture and patients symptoms. Also when other nerve related abnormalities need to be ruled out, e.g. diabetes, carpal tunnel syndrome, primary neuropathies and myopathies. EMG-NCV will give a baseline value for neurological condition against which recovery can be assessed in future.
  6. Blood Tests: Various blood tests might be required to rule out vitamin deficiency (B12), infection, and tumors.
  7. Other tests: Specific tests to confirm/ rule out infection and tumors might be required, if these conditions are suspected (CT guided biopsy, Histopathology, Culture and Sensitivity etc.)

Cervical Myelopathy Treatment:

Cervical Spinal stenosis is an irreversible pathology. Treatment for spinal stenosis is usually based on severity of patients symptoms and response to given treatment.

  1. Medical treatment: An initial course of pain killer medicines along with local application of pain relieving ointments are used to soothe pain. Other medications are given to make nerve more resistant to painful stimuli to reduce nerve related symptoms (radiculopathy, tingling, numbness). A spinal brace is given to eliminate excessive motion at painful spinal segment and to provide support to spine. Some amount of activity restriction is advisable to prevent worsening of symptoms.
  • Epidural Injection: Epidural injection can be tried to reduce radiculopathy symptoms. However, they don’t usually help with other symptoms as epidural injection doesn’t reverse spinal stenosis. Epidural injections cannot be given to patients with uncontrolled diabetes and patients on blood-thinner therapy for heart conditions.
  • Surgical Decompression of Spinal Cord: Patients who have severe symptoms to start with or those who don’t respond to above treatment with significant restriction of their day to day activities, usually need removal of pressure from spinal cord. This can be done in various ways-
  1. Anterior Cervical Spine Surgery: A minimally invasive procedure using a microscope to perform anterior cervical discectomy and/ or corpectomy with fusion done. This is done when pressure on spinal cord is primarily anterior.
  2. Posterior Cervical Spine Surgery: Patients with primary pressure on posterior aspect and multilevel compression are better benefited by a posterior surgery. A laminectomy with/ without fusion or laminoplasty can be done. Occasionally a targeted anterior procedure might be required in addition if there is associated anterior pressure and patient doesn’t recover completely after posterior only surgery.

Cervical myelopathy is a non-reversible condition which usually progresses. It is recommended to get the surgery done as soon as patient start having symptoms. Delaying surgery will lead to worsening of symptoms. These may not reverse completely even after the surgery due to permanent damage in spinal cord caused by long standing pressure.

A Thoracic Myelopathy will not affect upper extremities. However, part of the body below the level of compression will experience similar symptoms as in cervical myelopathy. This includes spasticity in legs, difficulty in standing and walking, and loss of bladder-bowel control. Ossification of ligaments is one of the main reason of thoracic myelopathy. This is more common in areas with fluorosis. Diagnosis and treatment protocols are similar to cervical myelopathy.

Cervical spondylosis and myelopathy are two conditions that affect the spine in the neck region. Cervical spondylosis refers to the natural degeneration of the discs and joints in the neck, usually caused by age, wear and tear, or injury. This can lead to a range of symptoms, including neck pain, stiffness, and headaches, as well as tingling, numbness, or weakness in the arms and hands.

When cervical spondylosis progresses, it can cause compression or damage to the spinal cord, resulting in myelopathy. Myelopathy is a neurological disorder that affects the spinal cord, causing symptoms such as difficulty walking, loss of coordination, and weakness or numbness in the legs or arms. Myelopathy can also affect bladder and bowel function and lead to problems with sexual function.

The diagnosis of cervical spondylosis and myelopathy usually involves physical examination and imaging tests, such as X-rays, magnetic resonance imaging (MRI), or computed tomography scans (CT).

Treatments for cervical spondylosis and myelopathy can vary depending on the severity the condition and the symptoms present. Conservative treatments may include pain medication, physical therapy, or bracing. In severe cases, surgery is necessary to relieve pressure on the spinal cord and prevent further damage.

Prevention measures for cervical spondylosis and myelopathy involve maintaining good posture, avoiding repetitive neck movements, and engaging in regular exercise to improve neck strength and flexibility.

In conclusion, cervical spondylosis and myelopathy are two conditions that affect the spine in the neck region, and they can cause a range of symptoms and complications. Early diagnosis and appropriate treatment can help manage symptoms and prevent further damage to the spinal cord. Adopting preventive measures can also help reduce the risk of developing these conditions

Cervical spinal stenosis and myelopathy are two medical conditions that affect the spinal cord. Cervical spinal stenosis refers to the narrowing of the spinal canal in the cervical region (the neck area), which may compress and damage the spinal cord. Myelopathy is a term used to describe the neurological symptoms that result from such damage to the spinal cord.

Cervical spinal stenosis can be caused by a variety of factors, including age-related wear and tear, degenerative changes in the spine, underlying medical conditions such as arthritis or herniated discs, or spinal cord injuries. Depending on the severity and location of the stenosis, patients may experience a range of symptoms such as neck pain, tingling or numbness in the arms or legs, weakness in the limbs, or difficulty with balance and coordination.

When cervical spinal stenosis results in compression of the spinal cord, it can lead to myelopathy. Myelopathy can cause a variety of symptoms, including difficulty walking, loss of fine motor skills, muscle weakness or atrophy, numbness or tingling in the hands and feet, and incontinence. In severe cases, myopathy can lead to paralysis or even death.

If left untreated, cervical spinal stenosis and myelopathy can lead to significant impairment and disability. However, with prompt diagnosis and appropriate treatment, many patients can experience significant improvement in their symptoms and quality of life. Treatment options for cervical spinal stenosis and myelopathy may include medication, physical therapy, braces or other supportive devices, or in some cases, surgery.

If you suspect that you may be experiencing symptoms of cervical spinal stenosis or myelopathy, it is important to see a doctor for evaluation and diagnosis. With proper care and management, many patients with these conditions can achieve significant improvement in their symptoms and overall health.

Introduction to Cervical Myelopathy Treatment without Surgery

Cervical myelopathy is a condition that results from compression or injury to the spinal cord in the neck region. Symptoms include weakness in the arms and legs, difficulty walking, coordination problems, and bladder or bowel dysfunction. Treatment for cervical myelopathy typically involves surgery, but there are also non-surgical options that may help alleviate symptoms.

Physical therapy is often recommended to strengthen the muscles supporting the spine and improve range of motion. This can help reduce pressure on the spinal cord and nerves. Specific exercises may include stretching, strengthening, and balance training.

Medications are prescribed to help manage symptoms. Nonsteroidal anti-inflammatory drugs (NSAIDs) can reduce pain and inflammation. Medications that target nerve pain, such as gabapentin, may be used to alleviate tingling or numbness in the arms or legs.

In some cases, cervical traction may be used to relieve pressure on the spinal cord and nerves. This involves applying gentle pulling force to the neck to create space between the vertebrae and allow for improved circulation and nerve function.

Acupuncture, massage therapy, and chiropractic adjustments may also be helpful in reducing pain and improving range of motion. However, it is important to discuss these options with a healthcare provider before beginning any treatment.

While non-surgical treatments for cervical myelopathy may help alleviate symptoms, they may not address the underlying cause of the condition. In some cases, surgery may be necessary to decompress the spinal cord and prevent further damage.

A healthcare provider can help determine the best treatment options based on your individual needs and medical history.

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