Myelopathy

What is myelopathy?

Myelopathy is a collection of symptoms caused by spinal cord compression. When something compresses (presses against or squeezes) your spinal cord, it can’t function properly. That can lead to pain, loss of feeling or difficulty moving certain parts of your body.

Your spinal cord is a collection of nerves that carry messages between your brain and body. It sits inside the hollow area of your spine (spinal canal). The bones in your spine (vertebrae) protect your spinal cord. Several diseases and conditions can weaken your vertebrae, along with other supporting structures in your spine, and cause them to compress your spinal cord.

You’ve likely lost feeling or felt pins and needles in your hand after leaning on your elbow for too long. Now, imagine if that feeling didn’t go away when you readjusted your position. Myelopathy can make everyday tasks like holding a pen or buttoning your shirt a real pain (in your neck and back).

Over time, myelopathy symptoms may get worse, so don’t hesitate to contact a healthcare provider if something doesn’t seem right. A provider can help you manage symptoms with nonsurgical options or treat myelopathy with surgery.

What are the types of myelopathy?

There are three types of myelopathy. Each one is named for the affected area of the spine:

• Cervical myelopathy. This is compression in your neck (cervical spine). The most common type of cervical myelopathy is degenerative cervical myelopathy (cervical spondylotic myelopathy), caused by natural changes to your spine as you age.
• Thoracic myelopathy. This is compression in the middle area of your spine, in your mid and upper back (thoracic spine).
• Lumbar myelopathy. This is compression in your lower back or lumbar spine (near your butt).

How serious is myelopathy?

If left untreated, myelopathy may get worse. It could lead to severe pain, permanent nerve damage and other severe complications like paralysis. Let a healthcare provider know if you experience symptoms of myelopathy.

What are the symptoms of myelopathy?

The symptoms of myelopathy may include:

• Pain in your neck or back
• Tingling, numbness or weakness in your arms, hands, legs or feet
• Difficulty with fine motor skills, like buttoning a shirt or grasping small objects
• Balance or coordination issues
• Loss of bladder or bowel control

Spinal cord compression affects the nerves that control many of your body’s movements and functions. Different areas of the spinal cord control different functions. Symptoms of myelopathy vary based on which part of your spinal cord it affects.

What causes myelopathy?

Anything that compresses your spinal cord can cause myelopathy. Common causes of spinal cord compression include:

• Herniated disk
• Infection and inflammation
• Neurodegenerative diseases (like Parkinson’s disease or ALS)
• Spinal stenosis
• Spondylosis
• Traumatic injury
• Tumor

What are the risk factors for myelopathy?

Myelopathy can affect anyone at any age. Degenerative forms of myelopathy are more common in adults over age 40. Research shows that people assigned male at birth (AMAB) develop myelopathy more often than people assigned female at birth (AFAB).

How is myelopathy diagnosed?

A healthcare provider will diagnose myelopathy after a physical exam, neurological exam and testing. During the exams, your provider will learn more about your symptoms and medical history.

To confirm a diagnosis, your provider will order tests. These tests may include:

• Imaging tests, like a spine X-ray, MRI or CT scan
• Myelogram, using contrast dye, along with imaging tests to show the relationship between bones and soft tissue in your spine
• Nerve function tests, such as electromyography or evoked potentials, to measure how your brain and body send messages

How is myelopathy treated?

Treatment for myelopathy varies based on where you have spinal cord compression and what caused it. The best treatment for you may vary from someone else. Your healthcare provider might recommend nonsurgical and/or surgical treatment options specific to your situation.

Nonsurgical myelopathy treatment

Nonsurgical treatments can help relieve symptoms, but they don’t decompress your spinal cord. If your symptoms are minor or you’re waiting for surgery, your provider may recommend nonsurgical care like:

• Wearing a brace
• Participating in physical therapy
• Taking medications, like pain relievers, corticosteroids or medications to treat inflammation

Myelopathy surgery

If you have myelopathy, surgery can decompress (relieve pressure on) your spinal cord. Your provider may consider surgery if nonsurgical options don’t relieve your symptoms or if your symptoms are severe enough to cause complications.

Surgeons use spinal decompression surgery to treat myelopathy. Your surgeon may use one or multiple procedure types to address myelopathy:

• ACDF surgery
• Diskectomy
• Disk replacement
• Laminectomy
• Laminoplasty
• Spinal fusion

Your surgeon will explain the risks and benefits of the procedure so you can make an informed decision about your health.

Can myelopathy be prevented?

You can’t always prevent myelopathy. Some myelopathy results from normal wear and tear due to aging.

You may be able to reduce your risk of some causes of myelopathy by taking steps to strengthen and care for your back. For example, be sure to lift heavy objects with your legs and core, not your back and upper body only. With good back care, you can reduce the likelihood or severity of some back injuries.

What’s the outlook for myelopathy?

It’s important to seek care if you notice symptoms of myelopathy. Even if your symptoms aren’t severe, they can still be irritating and make everyday tasks a little more challenging.

Left untreated, myelopathy may get worse over time. Spinal compression can damage the nerves that control your essential body movements and functioning. You can’t reverse nerve damage, so complications may be permanent. Surgery can treat this condition.

What is the life expectancy of a person with myelopathy?

This varies from person to person based on what caused symptoms and the severity. Myelopathy complications may affect your life expectancy and your quality of life. Your healthcare provider will give you the most up-to-date information on how myelopathy affects you and what you can expect.

When should I see a healthcare provider?

You should call your healthcare provider if you experience:

• Changes in your walking gait, loss of balance or clumsiness
• New or worsening pain in your neck or back
• Numbness, tingling or weakness in your hands, fingers, feet or toes

What questions should I ask my healthcare provider?

You may want to ask your healthcare provider:

• What is compressing my spinal cord?
• What type of treatment do you recommend?
• Are there side effects of the treatment?
• Will I need surgery?
• What’s the recovery time after surgery?
• Are there activities I should avoid?