Myelopathy

What is myelopathy?

Myelopathy describes a collection of symptoms that result from severe spinal compression. When something compresses (squeezes) the spinal cord, it can’t function properly. That can lead to pain, loss of feeling or difficulty moving certain parts of the body.

The spine encases the spinal cord — a collection of nerves that carry messages between your brain and body. Usually, the bones of the spine protect your spinal cord, preventing it from getting compressed. But traumatic injury to the spine, degenerative conditions like arthritis, tumors, infections and ruptured disks can cause enough pressure to affect or injure the spinal cord.

What are the types of myelopathy?

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

• Cervical spondylotic myelopathy. Cervical myelopathy occurs when you have compression in the cervical spine (neck).
• Thoracic myelopathy. When myelopathy develops in the middle area of the spine, it’s called thoracic myelopathy. The thoracic spine is in your mid and upper back.
• Lumbar myelopathy. The low back is called the lumbar spine. When myelopathy affects this area, it’s called lumbar myelopathy.

What causes myelopathy?

Anything that compresses the spinal cord can lead to myelopathy. Acute myelopathy occurs as a result of a sudden injury or infection. More commonly, myelopathy develops over time, often due to wear and tear or degenerative spinal conditions.

Myelopathy usually occurs as a result of spondylosis, a condition that causes slow degeneration of the spine. Spondylosis is a wear-and-tear condition. Healthcare providers and consumers may use this umbrella term to describe degenerative arthritis of the spine.

What is cervical spondylotic myelopathy (degenerative cervical myelopathy)?

Cervical spondylotic myelopathy is one type of spondylosis. It’s the most common type of myelopathy. People sometimes call it cervical spondylosis or arthritis of the neck.

What other conditions can cause myelopathy?

Other conditions that can lead to myelopathy include:

• Spinal stenosis. As you age, arthritis in the spine can narrow the spaces within your spinal column. This narrowing is called spinal stenosis.
• Ruptured or herniated disk. Sometimes, one of the disks that help cushion the spine herniates (bulges out between vertebrae). Or it may rupture (leak fluid, flattening the disk). The herniated disk can push into the spinal cord, placing pressure on it.
• Spinal tumor. A spinal tumor (whether cancerous or not) can press on the spinal cord.
• Neurodegenerative diseases. Conditions such as Parkinson’s disease or ALS can affect nerve functions of the spinal cord.

What are the signs and symptoms of myelopathy?

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 depend on which part of the spinal cord is affected.

Some common symptoms include:

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

How is myelopathy diagnosed?

The most common symptoms of myelopathy are not unique to this condition. They can be mistaken for other disorders.

To accurately diagnose myelopathy, your healthcare provider will perform a thorough physical exam and order tests. These tests may include:

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

How is myelopathy managed or treated?

Treatment for myelopathy depends in part on what’s causing the condition. If myelopathy is due to an infection or tumor, your provider will treat that first.

Nonsurgical treatments can help relieve symptoms. But once the spinal cord is compressed, most people need surgery to relieve the pressure.

• Nonsurgical treatment. If your symptoms are minor or you are waiting for surgery, your provider may recommend nonsurgical care. These treatments can help relieve pain and other symptoms. Treatment might include bracing, physical therapy or corticosteroids.
• Surgery. Surgeons use spinal decompression surgery to remove a herniated disk, cyst, bone spur or tumor that’s pressing on the spinal cord. A laminectomy is a type of decompression surgery. During this procedure, a surgeon removes small bones (called lamina) from the spine. Removing the bones expands the space around the spinal cord.

How can I prevent myelopathy?

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

But taking steps to strengthen and care for your back can prevent some causes of myelopathy. With good back care, you can reduce the likelihood or severity of some back injuries. Good back care includes:

• Lift heavy objects safely. Bend at your knees, tighten your abdominal muscles and use the strength of your legs to help you lift. If you can’t safely lift something on your own, find someone to help.
• Maintain a healthy weight. Excess weight puts more pressure on the spine.
• Stop smoking. In smokers, spinal disks tend to degenerate faster.
• Strengthen the core muscles in your back and abdomen. Exercises like crunches, planks or pilates can help.

What is the prognosis (outlook) for people with myelopathy?

Left untreated, myelopathy can get worse over time. Spinal compression can permanently damage the nerves that control essential body movements and function. You can’t reverse nerve damage, so it is important to get care as soon as you notice symptoms.

Early diagnosis and treatment can help improve your condition and, in some cases, reverse damage to the spinal cord.

When should I call the doctor?

You should call your healthcare provider if you experience:

• Change 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 should I ask my doctor about myelopathy?

You may want to ask your healthcare provider:

• What is causing compression of my spine?
• Will I need surgery?
• Are there lifestyle changes I can make to help my condition?
• Are there activities I should avoid?

A note from Cleveland Clinic

Spinal compression causes myelopathy. This collection of symptoms includes back pain, neck pain and tingling or numbness. Early treatment to relieve pressure on the spinal cord can improve symptoms and prevent permanent damage.